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Search Term: 'physician fingerprint form'

IMLC FAQ - Tab #1 General

“... 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. ”

This content is located on the following page(s): IMLC FAQs

Specialties

“This section of the physician profile contains the physician reported primary and secondary areas of practice. ”

This content is located on the following page(s): Physician Profile Descriptions

Out of state addresses - not able to register delegation online

“... accept delegation locations outside of Texas. Any physician, PA or APRN who does not have a TX practice address and needs to register prescriptive delegation, please contact the Registration Department at Registrations@tmb.state.tx.us .   ”

This content is located on the following page(s): Online Supervision and Delegation Registration System

CME - MD - NEW CME Requirements - Tab 5

“... were multiple bills passed requiring physicians, physician assistants and other licensees to complete certain specific opioid related continuing medical education.  These new CME requirements outlined above apply to the renewal of a license on or after September 1, 2020.     New ... ”

This content is located on the following page(s): Resources - CME for MD/DOs

Education

“This section of the physician profile contains the physician reported name, location and graduation date of all medical schools attended by the physician.   Also displayed is the physician reported graduate medical education taken in the US or Canada, including the following: Program name, Loca ... ”

This content is located on the following page(s): Physician Profile Descriptions

E-Prescribing Waiver

“... l condition; or before January 1, 2021.   A physician may apply for a waiver from the electronic prescribing requirement by: submitting a waiver request to the TMB and providing required information, and demonstrating circumstances necessitating a waiver from the requirement, including econo ... ”

This content is located on the following page(s): Renewal - Electronic Prescribing Waiver

Specialty Board Certification

“This section of the physician profile contains any physician reported specialty certifications issued by a board that is a member of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists. ”

This content is located on the following page(s): Physician Profile Descriptions

Renewal Fingerprinting information

“Several types of licensees are required to submit their fingerprints for state and national criminal history background checks prior to renewal, per statutory requirements. Fingerprinting services are provided through IdentoGo by IDEMIA (formerly known as MorphoTrust USA, LLC) for a fee (see the Fin ... ”

This content is located on the following page(s): Renewals Physicians

Expert Consultants

“DIRECT DEPOSIT FORM 74-176 PAYEE CHANGE FORM 74-157 APPLICATION FOR TX ID NUMBER ”

This content is located on the following page(s): Expert Consultants

CE for AD Tab 2 - Exemptions

“... ; Acudetox Continuing Education Exemption Request Form

This content is located on the following page(s): CAE for Acudetox Specialists

Gold Designated Practice Status

“... andum of understanding with the patient's primary physician for treating and managing the patient           OR        If a clinic is currently certified by TMB as a Pain Management Clinic, the clinic must be operated by physicians who currently hol ... ”

This content is located on the following page(s): Gold Designated Practice

Physician Fingerprint FAQs

“... When do we have to do it? Can I complete the fingerprint requirement early? Can I get my fingerprints done anywhere? What is my Board issued 6-digit ID number? What if my Board issued ID number is only 5 digits long? What is the TMB “Service code” for IdentoGo? Why can&rsq ... ”

This content is located on the following page(s): Renewals Physicians

Title: Military Volunteer License Application

Description:

Document: ... t a two year Military Volunteer L icense to a physician who is licensed and in good standing, or was licensed and retired in good standing, as a physician in another state; and is or was authorized as a physician to treat personnel enlisted in a branch of the United States armed forces or ve ...

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Title: NCT Documentation Checklist & Eligibility Requirements

Description: NCT Documentation Checklist & Eligibility Requirements

Document: ... be expired) or birth certificate ☐ DPS/FBI Fingerprint Report All NCT applicants must submit fingerprints for state and national criminal history background checks . Please see TMB website for instructions . All arrests/charges must be reported on the application no matter how lo ...

Click to view in browser - NCT Documentation Checklist 01.2025.pdf
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Title: IT Qualification Data Sheet

Description: IT Qualification Data Sheet form

Document: ... Instructions: Important: Before completing this form, please save document to your local computer using the “save as” function. Use your name as a file name for the form (ex: JDoe). Please explain how you meet each of the minimum qualifications of the position by indicating the place of empl ...

Click to view in browser - TMB-IT-QDS-form.docx
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Title: Press Release November 4, 2022

Description: TMB disciplines 14 physicians at October meeting, adopts rule changes

Document: ... e and desist orders . The Board issued 255 physician licenses at the October meeting , bringing the total number of physician licenses issued in Fiscal Year 2023 to 960 . RULE CHANGES ADOPTED CHAPTER 195. PAIN MANAGEMENT CLINICS The amendments to 195.1 - 195.4 , concer ...

Click to view in browser - pr-20221104.pdf
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Title: Press Release December 23, 2024

Description: TMB disciplines 18 physicians at December meeting

Document: ... license; and publicly referring him to the Texas Physician Health Program (TXPHP). The Board found that Dr. Joshi suffers from impairment and resigned his position May 1, 2024, based on unprofessional conduct and failing to meet the standard of care for one psychiatric patient. Lenz, Paul Albert, M ...

Click to view in browser - pr-20241223.pdf
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Title: Medical Board 2021 - October - Full Board Minutes

Description: Medical Board 2021 - October - Full Board Minutes

Document: ... r her work with the agencyAgenda Item #19, Report Physician Assistant Liaison. SandraLongoria was present. Consent Agenda, Discussion/Action Items to be considered and any time the full board is in session:Consideration and approval of the August 20, 2021 and September 17, 2021 Medical Board Meeting ...

Click to view in browser - MB-2021-Oct-Full-Board-Minutes.pdf
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Title: Medical Board 2021 - December - Licensure Committee Minutes

Description: Medical Board 2021 - December - Licensure Committee Minutes

Document: ... r. Nayak the motion passed. Agenda Item 2b. Physician licensure applicants to be licensed. Ms. Unterborn reported that there were 1 2 3 applicants who met all requirements to be considered for permanent licensure by the full Board. Dr. Naidu mo 1 2 3 physician licensure applican ...

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Title: Non-Profit Organizations - 162.001(b) Biennial Report Instructions Checklist

Description: Non-Profit Organizations - 162.001(b) Biennial Report Instructions Checklist

Document: ... establish ethical and religious directives and a physician may contractually agree to comply with those directivesTheboarddirectorshasdevelopedpoliciesthehealth organizationforthefollowingareas:credentialing qualityassurance utilizationreview peerreview Thehealthorganization’spoliciesmust rese ...

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Title: 162.001(b) Initial application

Description: Application for initial certification: Certified 162.001(b) nonprofit Health Organization

Document: ... erm "Supplier" as used in this letter means (i) a physician retained to provide medical services to or on behalf of the Corporation, or (ii) any other person providing or anticipated to provide services or supplies to or on behalf of the Corporation in excess of $10,000 during a twelvemonth period.F ...

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Title: PA Statistics 2021 May - In and Out of State

Description: PA Statistics 2021 May - Physician Assistant by In and Out of State

Document: GENDERINSTATEOUTSTATETOTA L 60211604762527085863294UNKNOWN171188746219110937PROGRAMINSTATEOUTSTATETOTA L GRADUATE537810436421335811474505101118746219110937RACETOTA L originnonNATIVE954063ASIAN98800889AMERICAN175160533ISLANDER221023OTHER3641490513UNKNOWN0000WHITE11755550067251576717008746 RACETOTA L ...

Click to view in browser - pa-stats-2021-May-in-out-state.pdf
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Title: Physician Cancellation by Request

Description: In order to request cancellation, a licensed physician must submit a notarized request form.

Document: 7 (;$6 0 (',&$/ %2$5' ȱȱ ȱ˜ŒŠ’˜—ȱ ›ŽœœDZȱŠ’•’—ȱ ›ŽœœDZȱ˜&#x ...

Click to view in browser - Cancellation Affidavit - 10-2022.pdf
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Title: PA Board 2020 November - Full Board Minutes

Description: PA Board 2020 November - Full Board Minutes

Document: exas Physician Assistant BoardBOARD MEETINGNovember 6The meeting was called to order on FridayNovember at a.m. by Karrie L Crosby,C, Presiding Officer. Agenda item #5, Physician Assistant Liaison Report. Ms. Millsprovided information regarding her attendance at the Texas Medical Board meeting on Oc ...

Click to view in browser - PA-2020-Nov-Full-Board-Minutes.pdf
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Title: Faculty Temporary License Application

Description:

Document: ... oney order ( payable through a US bank ) to this form. o S ubmit fingerprints for state and national criminal history background checks after Board receipt of application. Name: Provide your name as it is listed on either your current driver license issued by a state driver license burea ...

Click to view in browser - FTL Application 03.2025.pdf
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Title: Hardship Exemption Application

Description:

Document: ... LICANT: Please fill out all information on this form, and mail this form along with the required supplemental documentation with the $30.00 application fee to the address listed on this application. Once the application and accompanying documentation have been r eceived, a licensing analyst wil ...

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Title: Application Withdrawal Form

Description: ... o withdraw my application for licensure in Texas: Physician Assistant, Physician in Training (Internship, Residency, Fellowship Training), Surgical Assistant, Acudetox Specialist, Acupuncturist, Physician (M.D. or D.O.), Medical Radiologic Technologist, Non-Certified Radiologic Technician, Respirato ...

Document: ... Non - Certified Radiologic Technician Physician (M.D. or D.O) Respiratory Care Practitioner Physician Assistant Physician in Training (Internship, Residency & Fellowship Training) Perfusionist Surgical Assistant I wish to withdraw my ...

Click to view in browser - Application Withdrawal form 01.2025.pdf
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I didn’t receive my email renewal reminder.  How can I find that?

“... g them.  If you have any questions about the fingerprint requirements or the renewal process, please contact us at Registrations@tmb.state.tx.us. ”

Why can’t I find the IdentGo TMB “Service code” on the TMB website?

“TMB is not legally able to receive fingerprint results for individuals who are not existing applicants or licensees, and is not able to publicly provide the service code. This is why we provide the service code directly to licensees in the detailed instructions that are part of the email renewa ... ”

Can I complete the fingerprint requirement early?

“Yes, you can complete the fingerprint requirement at any point prior to your license expiration date. You do not need to wait for your expiration date. If you wish to submit your fingerprints early, please contact us at Registrations@tmb.state.tx.us and request your 6 digit ID number and i ... ”