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The items listed below MUST be completed and mailed to the LSBME as part of the initial application process.
Oath or Affirmation
This form must be notarized. All yes answers must be accompanied by a sworn affidavit. A sworn affidavit is an explanation (in applicant’s own words) that must be typed and notarized. Note: If criminal history is found that you did not disclose, you will be required to submit a new Oath or Affirmation, a notarized affidavit as to why you did not disclose the information and a new processing fee equal to the initial licensure fee. It is important that you answer question 3 accurately and truthfully. Do not take the advice of friends, lawyer, etc.
Third Party Authorization
This form must be notarized. It authorizes LSBME to obtain information concerning the applicant from third parties.
Certificate of Dean/Registrar
Complete Section 1 as directed. Mail to professional school/university for completion of Section 2. The school/university must mail the completed form directly to LSBME.
Background Check
LSBME conducts background checks as part of the application process. Instructions and forms can be found at the link above.
The board may, in its discretion, issue a temporary permit for the purpose of participating in unaccredited postgraduate fellowship training, at a minimum level of postgraduate year four (PGY-4), that is conducted by a Louisiana medical school or major teaching hospital, as defined herein, provided such school or major teaching hospital sponsors a fully accredited ACGME residency training program in the same specialty in which the fellowship training is offered.
QUALIFICATIONS FOR PERMIT
1. shall:
a. have completed a residency training program accredited by the ACGME, AOA or the Commission on Dental Accreditation (CODA) of the American Dental Association in the same specialty as the fellowship; and
b. possess all of the qualifications for licensing prescribed by §311A.1-6 of these rules;
2. present, or cause to be presented, to the board:
a. a completed application in a manner specified by the board, together with the fees prescribed by Chapter 1 of these rules;
b. satisfactory documentation that the applicant possesses the qualifications required by this Section; and
c. a letter from the program director under whom he or she will be serving in the fellowship, describing the capacity in which the applicant will be serving and the inclusive dates of such service.
3. Possess a standard Educational Council for Foreign Medical Graduates (ECFMG) certificate (if applicable)
4. Certified Examination Score Report
ADDITIONAL REQUIREMENTS
Birth Certificate/Valid Visa
· U.S. citizen - submit a notarized or certified copy of your birth certificate.
· U.S. citizen not born in the U.S. - submit a notarized copy of your certificate of citizenship, consular report of birth abroad or certificate of naturalization.
· Non-U.S. citizen - submit a notarized copy of current proof of citizenship. Acceptable forms of citizenship are an H1B Visa, J1 Visa, O1 Visa, TN Visa, Permanent Resident card or Employment Authorization card.
· Louisiana law (LA RS: 37.12) requires a valid permit to live and work in the United States to practice medicine.
· J1 Visas are structured for training and educational purposes only. The typical sponsor for a Medical Doctor’s J1 Visa is the ECFMG. A J1 visa is not for employment outside of a formal training program.
· H1B Visas are intended for those who are performing a specialized service or occupation. These Visas are usually sponsored by hospitals or a particular employer.
· The LSBME works with the United States INS to grant interlocking letters to obtain an effective date for the H1B Visa. The effective date of the Visa will be the effective date of the Louisiana license or permit issued by the LSBME.
· The applicant’s employer usually needs a valid LSBME license to complete the credentialing process for hospitals, insurance companies, and professional liability insurers. Therefore, the licensure applicant should work with the United States INS Visa sponsor to set the effective date for the Visa.
FEES
Fee must be paid via credit/debit card (Visa, MasterCard or Discover only).
Fee is non-refundable.
Licensure- $100.00
COMMUNICATION WITH THE BOARD
Mailing Address - LSBME, 630 Camp Street, New Orleans, LA 70130
Questions - Contact our licensing department at licensing@lsbme.la.gov. To find the analyst directly assigned to your application, click on Contact Us.