Wis. Admin. Code Medical Examining Board § Med 4.02 - Applications, credentials, and eligibility

Current through November 29, 2021

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.

(4) A recent photograph of the applicant as required under s. Med 1.02(4).

(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.

Notes

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. 13.92(4) (b) 6, Stats., Register November 2011 No. 671.