Follow the steps to complete your application seamlessly.

1. Select the ‘Get Form’ button to access the application and open it in your preferred editing tool.
2. Begin in Section 1 by providing your identification and contact information. Enter your last name, first name, middle initial, and any relevant suffix. Fill in the mailing address, city, state, zip code, email address, phone number, fax number, National Provider Identifier, California Professional License Number, and license expiration date.
3. Proceed to Section 2 to input your educational background. Specify the name of the Medical, Osteopathic, or Pharmacy school you attended, along with the degree earned and date it was conferred.
4. In Section 3, outline your qualifying knowledge or expertise related to the committee. Mark whether you have experience in clinically appropriate prescribing or dispensing of covered drugs, and explain your experience in the provided spaces.
5. Complete Section 4 by affirming your current professional status. State whether you are an actively engaged physician or pharmacist.
6. In Section 5, attach your Curriculum Vitae, a completed Conflict of Interest Disclosure Form, and any other relevant materials that support your application.
7. Move on to Section 6, where you will initial each affirmation. This confirms that you agree with the statements regarding your employment status, license status, and criminal convictions. Attach explanations for any statements you cannot affirm.
8. Finally, in Section 7, verify all the information you provided by signing and dating the application. Ensure that your declaration is accurate and complete.
9. After completing the form, save your changes. You may then download, print, or share the completed application as needed.

Start filling out your CA MTUS PT-APP online today to take the next step in your professional journey.