Virginia Administrative Code (Last Updated: January 10, 2017) |
Title 18. Professional and Occupational Licensing |
Agency 85. Board of Medicine |
Chapter 20. Regulations Governing the Practice of Medicine, Osteopathic Medicine, Podiatry,And Chiropractic |
Appendix 9998. FORMS (18VAC85-20)
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Information and Chiropractic Endorsement Application (rev. 12/08).
Information and Podiatry Endorsement Application (rev. 12/08).
Instructions and Application for a License to Practice Osteopathic Medicine (rev. 1/09).
Form A, Claims History Sheet (rev. 8/07).
Form B, Activity Questionnaire (rev. 10/09).
Form C, Clearance from Other State Boards (rev. 11/09).
Form E, Disciplinary Inquiry (rev. 5/11).
Form H, Federation of Podiatric Medical Boards Report (rev. 12/08).
Form A, Intern/Resident, Memorandum from Associate Dean of Graduate Medical Education (rev. 8/07).
Form B, Intern/Resident, Certificate of Professional Education (rev. 8/07).
Form G, Intern Resident, Request for Status Report of ECFMG Certification (eff. 8/07).
Form H, Report of Clinical Rotations (rev. 12/02).
Transfer Request, Intern/Resident (eff. 8/07).
Instructions for Completing an Application for a Limited License to Foreign Medical Graduates Pursuant to 54.1-2936 (rev. 8/07).
Application for a Limited License to Foreign Medical Graduates Pursuant to 54.1-2936 (rev. 8/07).
Form L, Certificate of Professional Education (rev. 12/08).
Instructions for Reinstatement of Medicine and Surgery Licensure Application (rev. 4/08).
Application for Reinstatement of License to Practice Medicine (rev. 3/09).
Form A, MD Reinstatement, Claims History Sheet (rev. 9/09).
Form B, MD Reinstatement, Activity Questionnaire Form (rev. 8/07).
Form C, MD Reinstatement, State Questionnaire Form (rev. 8/07).
MD Reinstatement, Disciplinary Inquiries to Federation of State Medical Boards (rev. 8/07).
Instructions for Reinstatement of Osteopathic Medicine Licensure Application (rev. 4/08).
Application for Reinstatement of License to Practice Osteopathic Medicine (rev. 8/07).
Form A, Osteopathy Reinstatement, Claims History (rev. 8/07).
Instructions for Reinstatement of a Chiropractic Licensure Application (rev. 4/08).
Application for Reinstatement of License to Practice as a Chiropractor (rev. 8/07).
Instructions for Reinstatement of Podiatry Licensure Application (rev. 4/08).
Application for Reinstatement of License to Practice Podiatry (rev. 8/07).
Reinstatement Application Instructions for Medicine & Surgery or Osteopathy Licensure after Reinstatement Denied or License Revoked (rev. 8/07).
Reinstatement Application Instructions for Medicine & Surgery or Osteopathy Licensure after Mandatory Suspension, Suspension or Surrender (rev. 8/07).
Reinstatement Application Instructions for Podiatry Licensure after Mandatory Suspension, Suspension or Surrender (rev. 8/07).
Application for Reinstatement of License to Practice Medicine/Osteopathy After Petition for Reinstatement Denied or License Revoked (rev. 8/07).
Application for Registration for Volunteer Practice (rev. 8/07).
Sponsor Certification for Volunteer Registration (rev. 8/08).
Guidelines for Completing the Practitioner Profile Questionnaire (rev. 7/11).
Practitioner's Help Section (rev. 11/10).
Practitioner Questionnaire (rev. 7/11).