Board of Medical Examiners

Applications for Licensure as a Medical Doctor

1.  Application for Medical Doctor Licensure in Tennessee  (Paper Application)
   
   • Full Medical Doctor License Checklist and Forms
   • Distinguished Faculty License Checklist and Forms
   • Foreign Training License Checklist and Forms
   • Graduate Physician License Checklist and Forms
   • Locum Tenens License Checklist and Forms
   • Short Term Clinical Visitor License Checklist and Forms
   • Single Purpose License Checklist and Forms
   • St. Jude License Checklist and Forms
   • Temporary License Checklist and Forms 
   • Convert Limited License to Full Checklist 
2.  Application for a Special Training License as a Medical Doctor (Paper Application)

• Special Training License Checklist and Forms

     3.   Application for Licensure Reinstatement

     4.  Renewal Application

     5.  Application for Special Volunteer License 

     6.  Application for Volunteer Health Care Services

Portability Act for Military and Military Spouse with transfer Orders to Tennessee

Please fill out the application below and email to Medical.Health@tn.gov with a copy of the military orders

• Portability Act Application 

Forms

1. Declaration of Citizenship (PH-4183)
2. Declaration of Eligibility for Expedited Licensure Process for a Military Member (PH-4279) 
3. Declaration of Eligibility for Expedited Licensure Process for a Spouse of a Military Member (PH-4280) 
4. Request for Duplicate License (PH-4058)
5. Name and Address Change Request 
6. Affidavit of Retirement (PH-3460)
7. Reporting of Convictions of Physicians
8. Petition for Declaratory Order
9. Request for Advisory Ruling
10. Public Record Request Form

 

Interstate Medical Licensure Compact 

► The Interstate Medical Licensure Compact (IMLC) is an alternative pathway to medical licensure for physicians seeking to practice medicine in multiple states. The IMLC creates a streamlined process for obtaining multiple state licenses. Applicants for licensure through the IMLC must meet the rigorous qualifications for licensure which are established under the compact. 

Tennessee is one of more than forty states participating in the IMLC. For a complete list of participating states, minimum applicant qualifications, and information how to apply for licensure through the IMLC, please visit the Interstate Medical Licensure Compact Commission website at www.imlcc.com. 

Anesthesiologist Assistant

• Application for Anesthesiologist Assistant

Office Based Surgery

• Office Based Surgery Level II & Level III Unanticipated Events Report (PH-4071)
• Application for Office Based Surgery (PH-3963)

 

Genetic Counselors

• Genetic Counselors Application (PH-4039)

Radiologist Assistant

• Application for Licensure as a Radiologist Assistant  (PH-3887)