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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 2011 - August - Licensure Committee Meeting Minutes
Document: TEXAS MEDICAL BOARD LICENSURE COMMITTEE MEETING MINUTES August 25, 2011
The meeting was called to order at 10:59 a.m. on August 25, 2011 by Chair, Michael Arambula, M.D. Committee members present were Pat Crocker, D.O., John D. Ellis Jr., Wynne M. Snoots, M.D., Paulette B. Southard, Timothy J. Turn ...
Description: Medical Board 2011 - August - Licensure Committee - Agenda Item 9: Modifications to Board Rules - 22 TAC 163 - Licensure
Document: ... clinical subjects, which shall be offered in the form of required patient-related clerkships, are internal medicine, obstetrics and gynecology, pediatrics, psychiatry, family practice, and surgery. (iv) The curriculum shall be of at least 130 weeks in duration. (v) There must be integrated institut ...
Description: Medical Board 2011 - August - Licensure Committee - Agenda Item 9: Modifications to Board Rules - 22 TAC 167 - Reinstatement and Reissuance
Document: ... ant shall execute the settlement agreement in the form of an agreed order or affidavit as soon thereafter as is practicable. If the applicant rejects the proposed agreement, the applicant shall be given the option of requesting a formal hearing. If the applicant requests a formal hearing, the matter ...
Description: Medical Board 2011 - August - Licensure Committee - Agenda Item 9: Modifications to Board Rules - 22 TAC 171 - Postgraduate Training Permits
Document: ... uspended for cause, revoked or subject to another form of discipline in a state or territory of the United States, a province of Canada, or a uniformed service of the United States; (B) an investigation or proceeding pending against the applicant for the restriction, cancellation, suspension, revoca ...
Description: Medical Board 2011 - August - Licensure Committee - Agenda Item 9: Modifications to Board Rules - 22 TAC 172 - Temporary and Limited Licenses
Document: ... f Texas. (5) The physician must sign an oath on a form provided by the board swearing that the physician has read and is familiar with board rules and the Medical Practice Act; will
TEXAS MEDICAL BOARD RULES Texas Administrative Code, Title 22, Part 9
Proposed Changes
Chapter 172
Temporary and Li ...
Description: Medical Board 2011 - August - Licensure Committee - Agenda Item 9: Modifications to Board Rules - 22 TAC 184 - Surgical Assistants
Document: ... e in effect at the time the completed application form and fee are received by the board; (6) must have the application for licensure complete in every detail at least 20 days prior to the board meeting at which the applicant is considered for licensure. An applicant may qualify for a temporary lice ...
Description: Medical Board 2011 - August - Licensure Committee - Agenda Item 9: Modifications to Board Rules - 22 TAC 192 - Office-Based Anesthesia Services
Document: ... el I services, shall register with the board on a form prescribed by the board and pay a fee to the board in an amount established by the board. (b) The board shall coordinate the registration required under this section with the registration required under the Medical Practice Act, Texas Occupation ...
Description: Medical Board 2011 - February - Licensure Committee Meeting Minutes
Document: ... TAC 166.7 Report of Impairment on Registration Form. Mr. Turner moved to recommend to the full board that the rules be published in the Texas Register for public comment. Ms. Southard seconded. All voted in favor. The motion passed.
Agenda Item 10 - Discussion, recommendation, and possible actio ...
Description: Medical Board 2011 - February - Licensure Committee - Agenda Item 9b - Board Rule 166.7 - Reports of Impairment
Document: ... aft
§166.7. Report of Impairment on Registration Form. (a) A licensee who reports an impairment that affects the licensee's ability to actively practice medicine as defined by Section 163.11(a) of this title (relating to Active Practice of Medicine) shall be given written notice of the following: ( ...
Description: Medical Board 2011 - June - Licensure Committee - Agenda Item 3e1: Physicians to be Licensed
Document: ... 5)
176.
FULLREG (491445) SCHOOL: CENTRE UNIV DE FORM ET PERFECT DES PROF DE SANTE (C U F), HO CHI MINH-1995 VO, DAI TRAN MD
177.
FULLREG (541762) SCHOOL: MICHIGAN STATE UNIV COLL OF HUMAN MED, EAST LANSING1981 WAGAR, ELIZABETH ANN MD FULLREG (553132) SCHOOL: TRIBHUVAN UNIV, INST OF MED, MAHARAJ ...
Description: Medical Board 2011 - November - Full Board Committee Meeting Minutes
Document: ... repositories and draft a board statement for the newsletter regarding the use of expired drugs during a shortage. Agenda item #7, Discussion, recommendation, and possible action regarding pending litigation. Dr. McMichael moved, Ms. Southard seconded, and the motion passed to go into Executive Sess ...
Description: Medical Board 2011 - November - Licensure Committee Meeting Minutes
Document: TEXAS MEDICAL BOARD LICENSURE COMMITTEE MEETING MINUTES November 3, 2011
The meeting was called to order at 10:37 a.m. on November 3, 2011 by Chair, Michael Arambula, M.D. Committee members present were John D. Ellis Jr., Wynne M. Snoots, M.D., and Paulette B. Southard and Irvin E. Zeitler Jr. D.O. ...
Description: Medical Board 2012 - April - Disciplinary Process Review Committee - Agenda Item 02 - DPRC TX PHP Report
Document: ... a working telephone or email address and the only form of communication is through fax. The participant is out of compliance with the semi-annual reporting requirement from his neurologist, which was due by 12/15/11. Clinical coordinator contacted the neurologist regarding the report and he stated t ...
Description: Medical Board 2012 - April - Licensure Committee Meeting Minutes
Document: ... to mental impairment on the registration/renewal form and the licensure application. The Committee directed staff to review the two forms, highlight all discrepancies, and return to the Committee for review.
Agenda Item 9 Discussion, recommendation and possible action regarding stakeholder group t ...
Description: Medical Board 2012 - April - Licensure Committee - Agenda Item 6: Proposed changes to Board Rule 163
Document: ... s which are in effect at the time the application form and fee are filed with the board; (6) may be required to sit for additional oral, written, mental or physical examinations that, in the opinion of the board, are necessary to determine competency and ability of the applicant;
(7) must have the ...
“... 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.