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“... st by submitting a completed Application Withdraw Form to Compact-General@tmb.state.tx.us. Once that has been received and processed, you can submit your application through the IMLCC. ”
“... equest a waiver
The Electronic Prescribing Waiver form is available for submission through your MyTMB account.
Verification of an approved waiver will be displayed on the physician profile once granted.
Once approved, waivers will be issued for a period of one year.
Physicians may app ... ”
“DIRECT DEPOSIT FORM 74-176
PAYEE CHANGE FORM 74-157
APPLICATION FOR TX ID NUMBER ”
“... ;
Acudetox Continuing Education Exemption Request Form ”
“... Pain Management Gold Designated Application Form and submit it along with the requested additional documentation:
Medical Home Agreement – provide a copy of the Medical Home Agreement, written collaborative, coordinated care agreement or memor ... ”
Description: Medical Board 2010 - April - Licensure Committee Meeting Minutes
Document: ... he applicant was convicted of failure to file IRS form 8300 for currency in excess for $10,000, i.e. $300,000 (misdemeanor) and was incarcerated for five months. Dr. Holliday seconded the motion. All voted in favor. The motion passed.
Applicant #929 appeared with counsel, before the Committee, in e ...
Description: Medical Board 2010 - August - Finance Committee Meeting Minutes
Document: ... Policies and Procedures and revised Travel Claim Form. She mentioned how convoluted the process is based on how rapidly the reimbursement rates change. She also stated that the agency must adjust constantly to remain in compliance with the Comptrollers guidelines on travel policies. She explained t ...
Description: Medical Board 2010 - August - Full board Committee Meeting Minutes
Document: ... ard that are up and functioning to distribute the newsletter and board updates. Ms. Robinson gave a report on the Texas Physician Health Program website that is available to provide a source of information about the health program. A web link to the Physician Health Program will be accessible from t ...
Description: Medical Board 2010 - August - Licensure Committee Meeting Minutes
Document: ... that the information submitted on the application form was true and correct.
Agenda Item 16 - There being no further business, Dr. Arambula adjourned the meeting at 6:05 p.m.
Description: Medical Board 2010 - February - Full Board Committee Meeting Minutes
Document: ... r discussion of the release of information in the Newsletter, the board directed staff to research the different options for the release of physician information in the Newsletter regarding Corrective Orders and to report back at the April board. Ms. Robinson requested the boards input on the discip ...
Description: Medical Board 2010 - June - Standing Orders Committee - Agenda Item 6 - Prescriptive Delegation Waiver Requests
Document: ... ation on the following pages. All sections of the form must be complete to be considered. Submit the application by email to verifcic@tmb.state.tx.us as an attachment. Each application will be placed on the Texas Medical Board website for public commentary for a minimum of 14 days. Only e-mail addre ...
Description: Medical Board 2010 - June - Public Information/Profile Committee Meeting Minutes
Document: ... her agencies. Agenda item #4, report on status of newsletter email distribution project: Ms. Hopper reported that email service vendors offer comparable services and presented a comparison of two such vendors that will enable TMB to communicate cheaply and more effectively with licensees, the public ...
Description: Medical Board 2010 - June - Standing Orders Committee - Agenda Item 6 - Site-Specific Prescriptive Delegation Statute & Rule
Document: Quick Reference Site-Specific Prescriptive Delegation Statute & Rule
5/22/2010
Use the table below to compare requirements between the four site types. Click on the underlines to see the relevant statute or rule. Full statute and rule regarding prescriptive delegation is at the end of this documen ...
Description: Medical Board 2010 - October - Finance Committee Meeting Minutes
Document: ... cess-Ms. Drabek stated that the process and claim form for travel expenses has been updated. She addressed that the new method for claiming expenses should reduce the processing time and allow for quicker reimbursement. She also stated that a detailed explanation of the new claim form would be given ...
Description: Medical Board 2010 - October - Public Information/Profile Committee Meeting Minutes
Document: ... mail addresses obtained from license registration form. Ms. Hopper briefed the board on the issue of amending current language on the physician biennial registration form that asks licensees whether their contact information can be used for non-emergency communication from TMB. Ms. Robinson recommen ...
Description: Medical Board 2010 - October - Standing Orders Committee Meeting Minutes
Document: ... enda Item 5 Report on revisions to waiver request form Ms. Garanflo reported on revisions made to the prescriptive delegation waiver request application. The committee directed staff to revise the prescriptive delegation request form to include a section on telemedicine. In cases where a requestor p ...
Description: Medical Board 2011 - April - Ad Hoc Committee on Advertising
Document: ... draft Board Certification Advertising Application Form and requested what documentation the committee needed to make determinations for approval of recognition of board certification for advertising. After discussion, the committee directed staff to have an application form for individuals and anoth ...
Description: Medical Board 2011 - April - Full Board Committee Meeting Minutes
Document: ... ation, 166.7 Report of Impairment on Registration Form, and publish in the Texas Register as adopted. Ms. Kaufman presented a brief summary of the presented amendments to Chapter 175. No written comments were received. No one signed in to present oral comments. After discussion, Dr. Holliday moved, ...
Description: Medical Board 2011 - April - Public Information/Profile Committee Meeting Minutes
Document: ... o language on the physician biennial registration form that enables licensees to let their contact information be used for nonemergency communication from TMB, in particular, news releases and newsletters. Agenda item #3, Update relating to website changes. Ms. Hopper briefed the board on the new la ...
Description: Medical Board 2011 - August - Full Board Committee Meeting Minutes
Document: ... ture; remedial plans will not be published in the newsletter or contained in the press release, but will be on the physician profile; a charge of $500 will be the administrative fee per year for the length of the remedial plan; a remedial plan may be offer only prior to a SOAH mediation; a remedial ...
“... this time, only physician applicants can use the Form Y to expedite an application. Should this change, notification will be posted. ”
Can I expedite my physician assistant application?
At this time, only physician applicants can use the Form Y to expedite an application. Should this change, notification will be posted.
“... cant. Applicants can find the appropriate request form on our website at Supplemental Forms "Form N". ”
My licensing analyst informed me that I need a foreign education evaluation. What do I need to do?
A foreign education evaluation is one tool the board uses in evaluating the medical education of a physician applicant who attended a medical school located outside the United States. The board will accept evaluations from the Foreign Credentials Service of America (FCSA). The cost of the evaluation is borne by the applicant. Applicants can find the appropriate request form on our website at Supplemental Forms "Form N".
“... ird party identification number or choose another form of payment. ”
Can my residency program (or other third party) pay my PIT application fee?
Yes. They must register with the TMB for bulk payment processing. Your program will receive a third party identification number which they should make available to you, if they wish to pay your application fee. On the payment page of the online application, select "Pay by Third Party Payment". Enter the third party identification number you were given in the "Third Party ID" field. Note: This number should not be confused with the TMB personal identification number, or your ACGME, AOA, or TMB Program Identification number. Be sure to enter a valid email address. You will receive an email if the application fee has not been paid within seven days. Your application will not be submitted to the Texas Medical Board until the fee has been paid. Entering an incorrect third party identification number will mean that your program, or other third party payer, is prevented from paying for your application, and you will have to submit a new application with the correct third party identification number or choose another form of payment.
“... your request, a completed Name Change Application form and a notarized copy of the legal document(s) that granted your name change, i.e. marriage license, divorce decree etc. ”
What do I need to do to change the name I use professionally?
You must provide us with a statement that gives an explanation of your request, a completed Name Change Application form and a notarized copy of the legal document(s) that granted your name change, i.e. marriage license, divorce decree etc.
“... cannot use the online system, a Change of Address form is available, but not required. Information on the new Change of Address system is available at: http://www.tmb.state.tx.us/page/change-address ”
Can I give my change of address over the phone?
No. However, changes in mailing or practice addresses can now be updated online in most situations. For those license types that cannot use the online system, a Change of Address form is available, but not required. Information on the new Change of Address system is available at: http://www.tmb.state.tx.us/page/change-address
“... at least 5 working days for the processing of the form, the fee and posting to the computer system. ”
Is the registration payment due before the expiration of a license?
Yes. The completed registration application and payment are due on or before the expiration date of the permit. However, you should allow at least 5 working days for the processing of the form, the fee and posting to the computer system.
“... ensees who choose to register through a hard copy form, when an online option is available. If an online option is not available (ex: license is delinquent or suspended at the time of registration) the additional processing fee will not be required. ”
Is it the same price to register online or by hard copy?
No. An additional processing fee of $50 will be charged to those licensees who choose to register through a hard copy form, when an online option is available. If an online option is not available (ex: license is delinquent or suspended at the time of registration) the additional processing fee will not be required.
“... istration, please submit a hard copy registration form with the correct pro-rated fee. Please note that payments for the incorrect OBA pro-rated fee will be voided, causing a delay in the registration process. You may email us to request a pro-rated registration form at registrations@tmb ... ”
How much does OBA registration cost?
The biennial registration fee for office-based anesthesia is a total of $210, per physician and should be combined with the biennial registration.
For off cycle OBA registration, please submit a hard copy registration form with the correct pro-rated fee. Please note that payments for the incorrect OBA pro-rated fee will be voided, causing a delay in the registration process. You may email us to request a pro-rated registration form at registrations@tmb.state.tx.us.
“... lity. A physician must report on the registration form if she or he has completed the required CME. However, newly licensed physicians are exempt from the CME requirements the first time they register. ”
Is a physician required to complete CME to register a license?
Yes. Physicians need to complete at least 24 hours of continuing medical education each year, at least half of which must be in formal courses. One hour of formal CME must be in medical ethics and/or professional responsibility. A physician must report on the registration form if she or he has completed the required CME. However, newly licensed physicians are exempt from the CME requirements the first time they register.
“... fax). Please use the PMC change of address form located here. ”
How do I submit a name change or change of address for my pain management clinic?
A name change or change of address for a registered pain management clinic must be submitted in writing (by mail or fax). Please use the PMC change of address form located here.
“... d directly to the state board of your request.The form is avaliable under Verification Request in the "Licensee Resources" section of our website. ”
How do I get a verification of my Texas license sent to another state?
Upon written request TMB will provide a state board verification to another state board regarding licensees. The verification includes: licensee's name, license or permit number, issue date, expiration date, disciplinary status, and our board seal will be affixed.
There is no fee for state board verifications. Please allow 10 working days to process your verification. The verification will be mailed directly to the state board of your request.
The form is avaliable under Verification Request in the "Licensee Resources" section of our website.
“... to set up an e-prescribing process. On the waiver form, you will have to specify any of the above categories you are experiencing. ”
How do I qualify for the waiver?
There are three different ways you can qualify for a waiver. If you or your practice is experiencing any of the following, you may qualify for a waiver:
On the waiver form, you will have to specify any of the above categories you are experiencing.