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Search Term: 'physician fingerprint form'

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

Continuing ED Tracking

“... , and report continuing education coursework. All PHYSICIAN, RESPIRATORY CARE PRACTITIONERS, ACUPUNCTURE, MEDICAL RADIOLOGIC TECHNOLOGISTS, ACUDETOX SPECIALISTS, MEDICAL PHYSICISTS AND SURGICAL ASSISTANTS licensees have access to establish a free, basic account with CE Broker. Beginning Ju ... ”

This content is located on the following page(s): Continuing ED Tracking

Title: PA Temporary License Affidavit

Description: PA Temporary License Affidavit

Document: ... without the executionof this affidavit, theTexas Physician Assistant Board(TPAB)will not issue me a temporary license pending final actionon myapplication for licensure.EXECUTEDthis the _________________day of_________________________ , 20_____________.__________________________________Applicant'sS ...

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Title: Physician Retirement Request Form

Description: ... rder to request the retirement status, a licensed physician must submit a notarized retirement request form

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

Click to view in browser - Retirement_Request_Form 02-2025.pdf
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Title: Physician Voluntary Charity Care Request Form

Description: ... ge to a voluntary charity care status, a licensed physician must submit a notarized request form

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

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Title: PA Retirement Request Form

Description: ... rder to request the retirement status, a licensed physician assistant must submit a notarized retirement request form.

Document: 7 (;$6 3 +

Click to view in browser - PA - TR affidavit 02-2025.pdf
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Title: Referring Physician Attestation Form

Description: For Physician applicants who report solo practice work history.

Document: PHYSICIAN LICENSURE – REFERRAL ATTESTATION LICENSURE APPLICATION PHYSICIAN LICENSURE - REFERRAL ATTTESTION Version 02.2025 Professional Evaluation Texas Medical Board IMPORTANT: This form is to be completed by applicants that are in solo practice ONLY and have not held ho ...

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Title: Press Release May 20, 2021

Description: Texas Board of Respiratory Care suspends Richmond respiratory care practitioner (Alvarado)

Document: ... that Mr. Alvarado is noncompliant with his Texas Physician Health Program monitoring agreement as he has had m ultiple positive drug screens as well as missed check - ins and drug screens since entering into the agreement . A temporary suspension hearing with notice will be held as soon ...

Click to view in browser - pr-20210520.pdf
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Title: Pain Management Clinic Registration Form

Description: ... c certification, please download and fill out the form below.

Document: ... the Texas Medical Board (TMB). Use this form to register for pain management clinic certification and re - certification. Instructions: The Pain Management Clinic initial registration application should be submitted by the primary physician owner. An ap ...

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Title: Pain Management Clinic Withdrawal/Cancellation Form

Description: ... l certification, please download and fill out the form below.

Document: ȱ˜ŒŠ’˜—ȱ ›ŽœœÇ±È±Š’•’—È± ›ŽœœÇ±È±˜—ŠŒÈ± ...

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Title: Press Release June 16, 2021

Description: TMB suspends El Paso physician (August)

Document: ... 0 or 800 - 248 - 4062 TMB suspends El Paso physician On June 14 , 2021 , a disciplinary panel of the Texas Medical Board temporarily suspended, without notice, the Texas medical license of Brian James August , M.D. (Lic. No. H9762 ) , after determining his continuation in th ...

Click to view in browser - pr-20210616.pdf
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Title: Press Release June 17, 2021

Description: TMB suspends Port Arthur physician (Ahmed)

Document: ... 00 - 248 - 4062 TMB suspends Port A rthur physician On June 17 , 2021 , a disciplinary panel of the Texas Medical Board temporarily suspended, without notice, the Texas medical license of Raees Ahmed , M.D. (Lic. No. N0595 ) , after determining his continuation in the pract ...

Click to view in browser - pr-20210617.pdf
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Title: Medical Board 2021 - March - Full Board Minutes

Description: Medical Board 2021 - March - Full Board Minutes

Document: ... umber is expected to grow.Agenda Item #17, Report Physician Assistant Liaison.Janeth Mills, PAwas present.Agenda Item #18, Considerationand possible action regarding pending litigation.Mr. Freshour gave an update on pending litigation. Agenda Item #, Report oTemporary Suspension Hearings.A report on ...

Click to view in browser - MB-2021-March-Full-Board-Minutes.pdf
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Title: Joint Ownership Annual Reporting Packet On or After June 17-2011

Description: Annual Reporting form for Jointly Owned Entities Formed On or After June 17, 2011.

Document: ȱ ŗŖȬŗŚȬŘŖŘŘȱ ——žŠ•ȱ›Ž™˜›’—È±™ŠŒ”ŽÈ±АŽÈ±Å—ȱ ȱ—’’ŽœÈ ...

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Title: Surgical Assistant License Application

Description: Surgical Assistant License Application

Document: ... with the $ 330.00 application fee in the form of a personal check͕ cashier’s check or money order payable to the Texas Medical Board͘ 3. Please note that Texas has a two - step application process – S creening and l icensing. During S creening͕ the applicant’s documents ...

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Title: Medical Board 2021 - June - Disciplinary Process Review Committee Minutes

Description: Medical Board 2021 - June - Disciplinary Process Review Committee Minutes: Agenda Item 02: TX PHP Report; Agenda Item 04: Enforcement Report; Agenda Item 07: List of Potential Expert Panelist; Agenda Item 11: Legal Dismissals; Agenda Item 11: Case List ...

Document: ... 1192 Physician568556585913 Physician Assistant38422232 Acupuncturist Investigations Opened 453 1260 1915 2127 Physician340103414931656 Physician Assistant17585583 Acupuncturist Surgical Assistant Investigation ...

Click to view in browser - MB-2021-June-DPRC-Committee-Minutes.pdf
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Title: Visiting Physician Temporary Permit Application

Description: Visiting Physician Temporary Permit Application (2025)

Document: ... xas 78768 - 2029 www.tmb.state.tx.us VISITING PHYSICIAN TEMPORARY PERMIT APPLICATION (Applicants should allow 30 days for processing of a Visiting Physician Temporary Permit) PLEASE TYPE OR PRINT CLEARLY Visiting Physician’s Information Name: __________________________________ ...

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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 ... ”