Physician Limited Application
- Washington State Limited Physician (MD) online application - for Washington State licenses only.
Required Items to Apply
- The Washington State Department of Health requires that only the applicant or licensee may complete an attestation for an application, or for continuing education. This is a legal attestation. Completion of the attestation by anyone other than the applicant may constitute a reportable felony offense. The Department of Health can take action against people for perjury or for making a false statement they know to be false.
- In order to avoid delays, make your AMA and FSMB profile accessible to the Commission prior to application submission.
- Payment of application fees.
For further information please see:
- Limited Licenses RCW 18.71.095
- Initial and renewal credentialing of practitioners; WAC 246-12-020; How to obtain an initial credential
There are additional items you may need to complete your application
If we need additional documentation, we will notify you by email.
Washington State law authorizes the Department of Health to obtain fingerprint-based background checks for licensing purposes. This check may be through the Washington State Patrol and the Federal Bureau of Investigation. We may require this if you have lived in another state or if you have a criminal record in Washington State. This would be at your own expense.
Other Items May Include:
- Declaration of No Social Security Number
- Postgraduate Training Program Director Verification and Evaluation of Training (PDF)
- Resident Physician Appointment Verification (PDF)
- Malpractice History (PDF)
- Licensing Board Verification (PDF)
If you have questions, contact our Customer Service staff at firstname.lastname@example.org