An applicant who holds a valid license to practice medicine and
surgery issued by another licensing jurisdiction of the United States or Canada
may apply to the board for temporary camp physician or locum tenens license and
shall submit to the board the following:
(1) A completed and verified application form
supplied by the board for this purpose.
(2) A letter from a physician licensed to
practice medicine and surgery in this state requesting the applicant's
services, or a letter from a camp organization or other recreational facility
of this state requesting the applicant's services.
(3) A verified photostatic copy of a license
to practice medicine and surgery in another licensing jurisdiction of the
United States or Canada issued to the applicant and verified documentary
evidence of the applicant's current eligibility to practice under that license
in that jurisdiction.
photograph of the applicant as required under s.
(5) A verified statement that the applicant
is familiar with the state health laws and the rules of the department of
health services as related to communicable diseases.
(6) The required fees made payable to the
Wisconsin department of safety and professional services.
Wis. Admin. Code Medical Examining Board § Med 4.02
Cr. Register, October,
1976, No. 250, eff. 11-1-76; cr. (6), Register, February, 1997, No. 494, eff.
3-1-97; correction in (5) made under s. 13.93(2m) (b) 6, Stats., Register,
December, 1999, No. 528; correction in (5), (6) made under s.
(b) 6, Stats., Register November 2011 No.