License Application Packets and Forms 

(includes Fact Sheets with licensure eligibility requirements and history)

Note:  PDF's and external links will open in a separate window

Acupuncturists

• Acupuncturist Application Packet (PDF)
  
  
• Acupuncturists Practice Act       

Athletic Trainer

• Athletic Trainer Application Packet (PDF)  
  
  
• Athletic Trainers Practice Act - MN Statutes 148.7801 to 148.7815  
  
  
• Athletic Trainer Protocol (PDF) - This protocol form must be updated and reviewed at the athletic trainer’s renewal time and kept on file by the athletic trainer.   It is recommended that the primary physician also retain a copy.   Do not submit to the Board unless requested.  

• Naturopathic Doctor Application Packet (PDF) 
  
  
• Registered Naturopathic Doctor Practice Act    

Physicians (FCVS may be used for verifications of medical education, postgraduate training, and ECFMG certification)

• Medical Practice Act  

• Telemedicine Registration Law 
  Laws concerning Telemedicine Registration.

  
  
• Physician Application Option 1 (PDF) – This packet requires physicians to complete, print and submit directly to the Board.   See the Board Meeting Schedule for the application deadlines.

The following individual forms are included in the packet but can also be downloaded separately:

Certification of Medical Education (PDF)

Facilities List (PDF)

Hospital Privileges Verification (PDF)

Malpractice History Report (PDF)

Physician Recommendation (PDF) 

Physician_Verification_of_Licensure (PDF)

Temporary Permit Application (PDF)

Treating Physician Statement (PDF)

Verification of Postgraduate Medical Training (PDF)

Verification of Specialty Board Certification (PDF)

• Physician Application Option 2 - Uniform Application (aka UA)  This application is partially submitted online for the basic core of information that may be shared with other states accepting the UA.  Minnesota has a specific addendum addressing our state requirements.  The Uniform Application for Physician State Licensure (UA) allows for quick, easy and convenient single and multi-state licensure application.  The Federation of State Medical Boards (FSMB) began collecting a one-time $50 physician service charge from all applicants utilizing the benefits of the Uniform Application for Physician State Licensure (UA) on October 27, 2011.  See http://www.fsmb.org/ua-faqs.html for details.

          See the Board Meeting Schedule for the application deadlines.

Other Physicians Forms

• Camp Doctor Application (PDF) – Physicians may treat patients participating in camp activities in MN after registering
  
  
• Competitive Athletic Event Physician Registration Application (PDF) – Physicians licensed to practice medicine in another state may provide medical services to participants at a competitive athletic event in Minnesota after registering with the Board. 
  
  
• Emeritus Application (PDF) - Formal recognition that a physician has retired in good standing
  
  
• Residency Permit Application (PDF) – A residency permit is required to participate in a training program unless a physician is licensed
  
  
• Telemedicine Registration Application (PDF) – Physicians who are practicing telemedicine from another state and do not have a full medical license must register
  
  
• Dispensing Drugs for Profit (PDF) – Statement must be filed if dispensing drugs for profit.  This law refers only to drugs that are:  1) to be administered orally; 2) ordinarily dispensed by pharmacists; and 3) not vaccines. 

Physicians Assistants

• Physician Assistant Application Form Packet (PDF)
  
  
• Physician Assistant Practice Act
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• Notice of Intent to Practice (This form must be completed and submitted to the Board prior to beginning practice as a PA. formerly Practice Setting Description) 
  
  
• Dispensing Drugs for Profit

Professional Firms

• Professional Firm Application Packet (PDF)
  
  
• Professional Firms Act 
  
  
• Professional Firms Rules       

Respiratory Therapists

• Respiratory Therapist Application Packet (PDF) 
  
  
• Respiratory Therapist Practice Act  

• Traditional Midwife Application Packet (PDF) 
  
  
• Traditional Midwife Practice Act