Uniform Application for Physicians

 

INTRODUCTION

Beginning in 2012 the Board of Medicine began working with the Federation of State Medical Boards to make available the Uniform Application process to those physicians seeking medical licensure in West Virginia.  The Uniform Application is an online process which permits physicians to incorporate information and documentation from their FCVS verification packet if they have developed one. For a onetime fee it also permits the application information to be stored so that it can be utilized for licensing applications in other states.

After many months of work and upon the recommendation of the Licensure Committee, the Board at its May 20, 2013, meeting gave final approval to adopt the Uniform Application

The Uniform Application may be used by initial applicants for a permanent medical license and those physicians seeking reactivation of their previously held West Virginia license that has been expired for more than one year.

You may access the Uniform Application by clicking on http://www.fsmb.org/licensure/uniform-application/

ADDTIONAL REQUIREMENTS

Criminal History Record Check - Prior to issuance of initial licensure.

Patient Injury Compensation Fund (PICF) - $125 PICF assessment fee paid upon completion of application and prior to issuance of license.

INSTRUCTIONS AND FORMS

The instructions are being provided here below for your review before beginning the application process. Applicants will still need to follow the link above to complete the on-line portion of the Uniform Application. The required forms are available here as “Affidavit” and “Addendum” and also when you access the Uniform Application and choose West Virginia as the recipient state.

The application is divided into two parts:

  1. the required original Affidavit and Addenda forms ;

  2. and the on-line Uniform Application portion received from the Federation of State Medical Boards. The $400 application fee is now paid at the West Virginia web portal after answering the professional practice questions.This will submit the Uniform Application to our Board as a pending application.

The date the application is received is determined by the receipt of the fully completed Affidavit and Addendum 1 forms in part one, which both must be physically sent to the Board office via mail or other delivery service. The Affidavit should be appropriately notarized with a current (less than 6 months old) color photo attached per the form instructions. Addendum 1 should be received fully completed (including the often overlooked Photo Declaration Date on page 1) and submitted with original dated signatures. When parts 1, 2 and the fee are received the review process begins.

Uniform Application Instructions and Forms September 2018