Guidelines for Submitting Your Application Packet
As the applicant, you are responsible for submitting a complete application packet to the Board office. We will not process your application until we receive all required items as explained on the checklist below. If your application packet is not complete within three months of filing, we will consider it abandoned and discard your application form and other documents received.
Obtain the required items listed below from the third party sources and submit them all together in a single packet to the Board office unless the instructions state that the third party sources will send the items directly to the Board office. When enclosing items from third party sources in your packet, send:
- originals – not copies – of the items
- envelopes in which you received the items
When to File
An Administrative Medical license allows physicians to use their medical and clinical knowledge, skill, and judgment only in an administrative capacity. File this application when you are a physician practicing administrative medicine and will not provide any of the following medical or clinical services:
- examine, care for or treat patients
- prescribe medications including controlled substances
- delegate medical acts or prescriptive authority to others
If providing any of the above services, you must file an Application for Physician License to Practice Medicine.
Requirements for All Applicants
Your application packet must include all of the following:
- Enclose the application instruction sheet with the applicable checklists completed.
- Submit completed, signed and notarized Application for Administrative Medical License form.
- Enclose the non-refundable processing fee by check or money order made payable to “State of Delaware.”
- If you ever held a medical or training license in any jurisdiction other than Delaware, a license verification from each jurisdiction where you have held a license is required. However, you will submit some verifications in your application packet, while others will come directly from the jurisdiction to the Board office. Read the following information about requesting verifications carefully:
- If a jurisdiction utilizes VeriDoc to process license verifications, you must request the verification from VeriDoc, not from the jurisdiction. VeriDoc will send the verification directly to the Board office, not to you. For a list, click VeriDoc Participating States.
- If you have ever held an Indiana license, request a digitally certified verification at http://www.in.gov/pla/verify.htm. The site will download a verification in pdf format to your computer. Print the pdf document and send it in your packet. Contrary to the instruction on Indiana’s site, please do not email the pdf document to the Board office unless the Board office asks you to do so.
- For all other jurisdictions, request the jurisdiction to send the verification to you and include it in your packet.
- You may use the Verification of Physician License form included with this application form to request the verification.
- You may wish to obtain an AMA Profile or AOA Profile in order to make sure that you request verifications of all licenses that you have ever held.
- Before requesting a verification, check whether the jurisdiction requires a fee.
- The jurisdiction’s seal must be affixed to the form.
- Remember to enclose the envelope in which you received the verification from the third party source.
- Verifications that you print off the internet or receive by fax will not be accepted.
- Unless an exception listed below applies, obtain a Service Letter from each healthcare facility where you currently have, or had within the past three years, either direct patient access or admitting or staff privileges.
- A responsible physician at the facility must sign the form.
- Remember to enclose the envelopes in which you received each Service Letter.
- You do not have to provide a Service Letter for the following practice situations:
- You were practicing as an intern, resident, fellow, or house physician for the past three years.
- Your practice for the past three years was via telemedicine with no direct patient access.
- You were a locum tenens with no direct patient access for the past three years.
- If you are currently in training, submit a signed letter from the program director of your training institution on the institution’s letterhead. It must state that you have successfully completed your first year of training and the anticipated date you will complete your training.
- If any of the following describes your situation, obtain two letters of reference from physicians who are familiar with you but are not related to you:
- You have practiced only as an intern, resident, fellow or house physician, or
- You were self-employed for the entire past three years, or
- You had no direct patient access during the past three years, or
- One or more of the facilities where you had direct patient access in the past three years no longer exists.
- If you answer “yes” to questions in the DISCLOSURES section—other than Questions 32, 34, 35—you must fully explain your answer. We suggest that you use the Physician Self-Report form for this purpose. However, if the Physician Self-Report does not fully cover your situation, submit a signed, notarized statement in lieu of or in addition the Physician Self-Report.
- Request a self-query from the National Practitioner Data Bank (NPDB) website at www.npdb.hrsa.gov. The self-query report will be mailed to your address. When you receive the report, enclose the original report in your application packet.
In addition, arrange for the Board office to receive the following documents directly from the third party sources.
- Complete the Criminal History Record Check Authorization form to request State of Delaware and Federal Bureau of Investigation criminal background checks. Follow the instructions on the authorization form to arrange to be fingerprinted. The State Bureau of Identification will send the report directly to the Board office.
- Complete, sign and submit the Delaware Child Protection Registry Request Form to the Department of Services for Children, Youth & Their Families following the instructions on the form. DSCYF will send the report directly to the Board office.
- If a jurisdiction where you have ever held a medical or training license uses VeriDoc to process their license verifications, request the verification from VeriDoc, not from the jurisdiction. VeriDoc will send the verification directly to the Board office. For a list, click VeriDoc Participating States.
Additional Requirement for FCVS Applicants
Delaware accepts the Federation Credentials Verification Service (FCVS) of the Federation of State Medical Boards (FSMB). If you are using the FCVS service, the following requirement applies in addition to the items listed in Requirements for All Applications above:
- Request your Physician Information Profile from FCVS at www.fsmb.org. FCVS will send the profile directly to the Board office.
Additional Requirements for Non-FCVS Applicants
If you are not using the FCVS service, the application packet that you submit must include all of the following in addition to the items listed in Requirements for All Applications above:
- Submit an 8 1/2″ X 11″ copy of your medical school diploma. If you are a foreign medical graduate, attach an English translation from a reputable translating organization.
- Obtain a Verification of Medical Education from each medical school you attended.
- The school’s seal must be affixed to the form. If no seal is available, the form must be notarized.
- Internet verifications or faxed verifications will not be accepted.
- If you graduated from a foreign medical school, submit 8 1/2″ X 11″ copy of your current and valid Educational Commission for Foreign Medical Graduates (ECFMG) certificate.
- Submit an 8 1/2″ X 11″ copy of your Postgraduate Education Training Certificate(s).
- Only training programs are those that have been approved by the Accreditation Council for Graduate Medical Education will be accepted.
- If you graduated from a program approved by the American Medical Association (AMA) or American Osteopathic Association (AOA) in the U.S. (or U.S. territory) or Canada, you must have completed one year of postgraduate training in the U.S.
- If you did not graduate from an AMA- or AOA-approved program, you must have completed three years of postgraduate training in the U.S.
- Obtain a Verification of Post Graduate Medical Education form from each program that you attended.
- The program’s seal must be affixed to the form. If no seal is available, the form must be notarized.
- Internet verifications or faxed verifications will not be accepted.
- Obtain a complete examination history, including all passing and failing attempts, from the following organizations:
- ECFMG – Request report at www.ecfmg.org.
- Federal Licensing Examination (FLEX), United States Medical Licensing Examination (USMLE), and Special Purpose Examination (SPEX) examinations administered by the Federation of State Medical Boards – Request report at www.fsmb.org.
- National Board of Medical Examiners (NBME) examination administered by the National Board of Medical Examiners – Request report at www.nbme.org.
- National Board of Osteopathic Medical Examiners (NBOME) Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) examinations administered by the National Board of Osteopathic Medical Examiners. Request report at www.nbome.org
- Qualifying Examination (QE) Part I and Part II conducted by the Medical Council of Canada for the purpose of awarding the “Licentiate of the Medical Council of Canada” (LMCC). Request report at www.mcc.ca.