Predetermination
Pursuant to
2017 Wisconsin Act 278, beginning August 1, 2018, prior to submitting an application for a credential, an individual may apply to the Department for a determination of whether the individual would be disqualified from obtaining the credential due to his or her conviction record. To apply for a predetermination, please fill out
Form #3085 and submit all required documentation specified on the form. Pursuant to
Wis. Stat. §
111.335(4)(e), the offenses or kinds of offenses that may result in a refusal, bar, or termination of licensure are published under Additional Resources on the left side of this page.
License Information
Fee Reduction
Pursuant to 2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee. Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the United States Department of Health and Human Services website at https://aspe.hhs.gov/poverty-guidelines, prior to submitting Form 3217.
Per Wis. Stat. § 440.08 (2), the required renewal date for the
Physician credential is 10/31/odd year. Should you receive your initial credential in the
months leading up to this date, you are still required to renew your license by
the statutorily defined date.
The State of Wisconsin Medical Examining Board is pleased to offer the new online application process for medical and osteopathic physicians called the Uniform Application for Physician State Licensure (UA). The UA will benefit physicians by reducing redundancy in filling out multiple applications when applying for licensure in multiple states. Physicians will be able to apply to multiple states by filling out the UA once, then directing it to additional states. Once completed, the UA can be imported to your state of Wisconsin license application, leaving only the state-specific instructions and addendums of the application to be completed. Visit the
Federation of State Medical Boards' website for further information.
In order to prescribe controlled substances, a Physician must obtain a DEA number. Please contact the
DEA for further information on obtaining a DEA number.
Pre-Credential Education Information
Graduation from a medical or osteopathic college approved by the board.
Application for Licensure
Application for Endorsement by Exam, Administrative Physician and Visiting Physician
OLAS (Online Licensure Application System) may be used to apply online. Note: Please see Form #570 for additional documents that are required along with an online application.
Administrative Physician License Information
This license is designed for an applicant whose primary responsibilities are those of an administrative or academic nature.
The holder of an Administrative Physician license may not examine, care for, or treat patients. An Administrative Physician license does not include the authority to prescribe drugs or controlled substances, delegate medical acts, issue opinions regarding medical necessity or conduct clinical trials on humans.
Applicants for an Administrative Physician license must also meet the same qualifications for licensure as applicants applying under
Wis. Stat. § 448.05 (2)(a) or (b).
Visiting Physician License Information
This license is designed for a graduate of a medical school or an osteopathic college that is approved by the Board and who is invited to serve on the academic staff of a medical school in this state as a Visiting Physician
The holder of a Visiting Physician license may practice medicine and surgery as defined in Wis. State Stat. 448.01 (9), providing such practice is entirely limited to the medical education facility, medical research facility, or the medical college where the license holder is teaching, researching or practicing medicine and surgery and only within the terms and restrictions established by the Board.
A Visiting Physician license is valid for one (1) year from the date of issuance and remains valid only while the holder is actively engaged in teaching, researching or practicing medicine and surgery and is lawfully entitled to work in the United States. The license may be renewed at the discretion of the Board.
| Form | Description |
|---|
|
570 | Application to Practice Medicine and Surgery |
| 3217 | Application for Fee Reduction (If applying for a fee reduction, this form must accompany the application for the credential.) |
|
571 | Authorization and Waiver |
|
2165 | Certification of Post-Graduate Training (not necessary if utilizing FCVS) |
|
2164 | Medical Education Verification Form (not necessary if utilizing FCVS) |
|
1445 | Physician Data Center Practitioner Profile Report from the Federation of State Medical Boards (not necessary if utilizing FCVS) |
|
2167 | Hospital, Facility and Employer Form (Form is not required for applicants who have only been employed in a strictly training capacity and have not done any moonlighting outside of their training.) |
|
3046 | Joint Commission Certified Hospital, Facility and Employer Verification (This form is
ONLY to be used by employment agencies to verify a complete list of facilities the applicant was placed at under the agency's employment. If only a single facility/employer is being verified, Form #2167 above should be used.) |
|
2829 | Malpractice Suits or Claims Form (if applicable) |
|
3085 | Application for Predetermination |
| 2252 | Convictions and Pending Charges (if applicable) |
|
3074 | License Transition Addendum |
| 3220 | Sports Physician Licensure Exemption Extension |
|
3071 | Fax Payment Form |
Application for Minnesota Licensees
|
2862 | Application for License to Practice Medicine and Surgery for Individuals with a Current Unrestricted Minnesota License |
| 3217 | Application for Fee Reduction (This form must accompany the application for the credential.) |
|
571 | Authorization and Waiver |
|
2165 | Certification of Post-Graduate Training (not necessary if utilizing FCVS) |
|
1445 | Physician Data Center Practitioner Profile Report from the Federation of State Medical Boards
(not necessary if utilizing FCVS) |
|
2829 | Malpractice Suits or Claims Form (if applicable) |
|
2252 | Convictions and Pending Charges (if applicable)
|
Application for Camp Physician or Locum Tenens
This license is designed for an applicant who holds a valid license to practice medicine and surgery issued by another licensing jurisdiction of the United States or Canada whose services have been requested by a Physician licensed to practice medicine and surgery in this state or by a Camp Organization or other Recreational Facility of this state.
The holder of a Camp Physician or Locum Tenens license may engage in the practice of medicine and surgery providing such practice is confined to the Camp or Recreational Facility, or geographical area for which the license is issued. The Locum Tenens license allows the applicant to temporarily maintain the practice of another Physician including providing emergency room services normally provided by the other Physician. A Camp Physician or Locum Tenens license shall expire 90 days from the date of its issuance and may be renewed for additional periods of 90 days each, but no such license may be renewed more than three (3) consecutive times.
| Form | Description |
|---|
|
568 | Application for Temporary Camp Physician or Locum Tenens License |
| 1445 | Physician Data Center Practitioner Profile Report from the Federation of State Medical Boards (not necessary if utilizing FCVS) |
| 2829 | Malpractice Suits or Claims Form (if applicable) |
|
2252 | Convictions and Pending Charges (if applicable)
|
Application for Resident Education License (formerly the Temporary Education Permit)
This license is designed for applicants who have been accepted into a post-graduate training program in a facility in this state approved by the Board under the provisions of Wis. Admin. Code Med 1.02(3), and accredited by the ACGME or AOA. The REL is required for the entire duration of your training or until a permanent license to practice medicine and surgery is granted.
The holder of a REL may, under the direction of a person licensed to practice medicine and surgery in this state, perform services requisite to the post-graduate training program in which the licensee is serving. Acting under such direction, the Resident Educational licensee shall also have the right to prescribe drugs and controlled substances, and to sign any certificates, reports or other papers for the use of public authorities which are required of or permitted to persons licensed to practice medicine and surgery.
The Resident Educational licensee shall confine training and entire practice to the post-graduate training program in which the resident educational licensee is taking their training.
A Resident Educational License to practice medicine and surgery is valid for one (1) year and may be renewed for additional one-year terms as long as the license holder is enrolled in their post-graduate training program.
| Form | Description |
|---|
|
564 | Application for a Resident Educational License |
|
2601 | Affidavit of Hospital Authority (Form must be submitted by training facility directly to DSPS.) |
|
3050 | Certificate of Professional Education Form (Form must be submitted by school directly to DSPS.) |
|
2329 | Application for Renewal of Resident Educational License |
|
2252 | Convictions and Pending Charges (if applicable)
|
Interstate Medical Licensure Compact
| Form | Description |
|---|
|
2687 | Authorization for Release of FBI Information |
|
3221 | Medical Examining Board Compact Affidavit |
|
3202 | Hospital, Facility, and Employer Verification (IMLC) |
|
IMLC | Interstate Medical Licensure Compact |