Application for License to Practice Medicine / Osteopathic Medicine in Indiana Uniform Licensure Application - See below for further information
*Important* - Please also review the Frequently Asked Questions for additional instructions.
1. Completed Application for Licensure - You may use either the Indiana Specific Application or the Uniform Licensure Application.
- Uniform Licensure Application - The UA is a standard licensure application form that can serve as the core of a state’s license application without replacing unique state-level requirements. The form facilitates online completion of an initial licensure application and is available to all state medical boards. By utilizing the UA, physicians can save the application for later use in another state. For physicians who use Federation of State Medical Board's Credentials Verification Service (FCVS), approximately 70% of the form can be auto-populated with data. The Federation of State Medical Boards charges a one-time $50 fee for the Uniform Application, in addition to the $250 Indiana licensure application fee.; The UA must be accompanied by a completed Addendum 1, Addendum 2 and the Affidavit and Release Form when submitted to the Indiana Professional Licensing Agency. Please use this flowchart as a resource when using UA application.
2. Criminal Background Check – Effective July 1, 2011 any physician seeking initial licensure will be required to submit to fingerprinting and a national criminal background check by the Indiana State Police. You may review the requirements for this process on our criminal background check information page.
3. Photograph – passport quality photo taken within the past three (3) months
4. Application Fee - $250 in the form of a check or money order to the Indiana Professional Licensing Agency.
5. (If applicable) License Verification or Letter of Good Standing - from each State in which you are or have ever been licensed, certified, or registered in any regulated health profession or occupation regardless of the status. You will need to contact each state to see what they require to process the verification. It must come directly from them. We do accept digital verifications; however, the verification must come directly from the State in which you were licensed in or from Veridoc.
6. Official Transcript - You must submit an official transcript of grades from the medical/osteopathic school showing your degree has been conferred and date of graduation. They must come directly from the school in an unopened envelope. Graduates of foreign medical schools must submit notarized copies of all subjects and grades (mark sheets). Include official translation if not in English. If you went to more than one medical/osteopathic school you will need to submit transcripts from all medical/osteopathic schools attended.
7. Medical Degree - You must submit a notarized copy of your medical degree. Include official translation if not in English.
8. Residency Postgraduate Training - You must submit proof of postgraduate training.& The program must be accredited by ACGME, AOA or Royal Canada. Those who have graduated from approved schools in the United States, its possessions or Canada must have at least one (1) year of postgraduate training, in the United States, its possessions or Canada.& Those who have graduated from schools outside of the United States, its possessions or Canada must have two (2) years of postgraduate training, obtained in a recognized program in the United States, its possessions or Canada. You must submit official proof of all postgraduate training programs you attended. You may submit proof in one of two ways, both are listed below:
- A notarized copy of your certificate of completion issued by the Hospital with beginning and ending dates
- An original letter from the postgraduate training program director with the seal of the program with beginning and ending dates. (Copies will not be accepted.)
9. (If applicable) ECFMG Certificate - If you are a foreign medical graduate, you must submit a notarized copy of your ECFMG certificate. If your ECFMG certificate has an expiration date you must request a permanent validation sticker from ECFMG.
10. (If applicable) Proof of Name Change - When the name on any document differs from the applicant’s name, a notarized or certified copy of a marriage certificate or legal name change must be submitted.
11. NPDB/HIPDB Report - Please contact the National Practitioner Data Bank/Healthcare Integrity and Protection Data Bank and request a report. The report will be sent directly to you. Do not open the report, but forward the unopened envelope to our office. If you do open the envelope please send the entire content and the envelope to our office.(There are not two copies of the report in the envelope but two separate reports and we need both for licensure purposes. We need the envelope it came in to show proof that it came directly from NPDB.) We will also accept an electronic copy of the NPDB/HIPDB only if the applicant forwards it to us directly from NPDB/HIPDB via email. The email must be forwarded from NPDB/HIPDB and show NPDB/HIPDB as the original sender. We CANNOT accept an electronic copy via email that the applicant has personally scanned or saved and then emailed to us. The NPDB/HIPDB can be directly forwarded to PLA3@pla.in.gov.
12. Examination Scores - Please request that your official FLEX; National Boards; USMLE or State Board scores be submitted by the appropriate agency directly to the Professional Licensing Agency. For exam administrator contact information or examination combination requirements please visit our examination information page.
Obtaining a Temporary 90 Day Permit
A ninety (90) day temporary permit may be issued to an applicant who holds and shows proof of holding a valid license to practice medicine in the Unites States, its possessions or Canada.
If you are requesting a ninety (90) day temporary permit; along with the first four (4) items listed above your must also submit:
- Proof of current licensure - You must submit a notarized copy of a license with a current expiration date (pocket card/billfold license).
- Additional temporary permit fee - $100.00; payable to Professional Licensing Agency.
A criminal background check is not needed before issuance of a temporary permit; however, it is required for full licensure.
The permit expires ninety (90) days from the date of issuance or when final action is taken on the application for full licensure.
If you have answered any of the questions on the application “yes” you must submit a notarized affidavit detailing the occurrence/situation, the outcome, date of occurrence, if it is a malpractice payment the amount paid in your behalf. If applicable please submit copies of all court documents and/or arrest records. Letters from attorneys or insurance companies are not accepted in lieu of your statement.
Question 13 "Have you practiced as a MD/DO either clinically or administratively in the last 3 years?" If you answer "YES" to this question, you do not need to send in a notarized affidavit concerning it. If you answer "NO" you should send in documentation as to what you have been doing. If you are a resident and are applying to obtain a new license for the first time you should write "resident" beside question 13 and not answer yes or no. If you have any questions please contact our office at (317) 234-2060.
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