Get Licensure Verification Information - Federation Of State Medical Boards - Fsmb

This guide provides clear instructions for completing the Licensure Verification Information form as required by the Federation Of State Medical Boards. Whether you are unfamiliar with the process or simply need a refresher, this guide will assist you in filling out the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Select the ‘Get Form’ button to obtain the Licensure Verification Information form and open it in your preferred online editor.
2. Begin by filling out Section 1, 'Applicant Information.' Input your last name, first name, middle name, date of birth, and Social Security number. Remember, the Social Security number is solely for identification purposes.
3. Continue in Section 1 with the authorization statement. State the board you are applying to and provide the board name and mailing address.
4. In Section 2, 'Licensure Verification,' include the name of the licensee. Be sure to fill in the issuing state board, current status of the license, license number, type, issue date, and expiration date.
5. Answer the questions regarding formal disciplinary proceedings. If applicable, provide explanations where necessary.
6. Conclude the form by signing where indicated, providing the date, and ensuring all sections are complete and accurate.
7. Once you have filled out the form, save your changes, and you may choose to download, print, or share the document as needed.

Complete your Licensure Verification Information form online today for a streamlined process.