• Properly completed, signed and notarized application, including Applicant Responsibility statement;
• Recent passport quality photograph (at least 2”x 2”) attached to application;
• Appropriate explanations and copies of all pertinent documentation must be attached for affirmative responses
  to questions numbered 8, 9, 10, 11, 12, 12a, 13, 14, 19, 27, 28, 29, 30, 31, 32, and 33;
• Release form, signed and notarized (Form A);

• Proper application, registration, AND criminal background investigation fees – cashier’s check or money order
  made payable to Nevada State Board of Medical Examiners (NSBME) or by credit card as instructed. Credit
  cards will only be accepted by receipt of the signed credit card authorization form.

Note: Application and criminal background investigation fees are non-refundable;

1. U.S. born citizens: Original or Certified Birth Certificate that bears an original seal or stamp of the issuing
   agency (notarized copies are not acceptable).
2. Foreign-born citizens: Original Certificate of Naturalization or current U.S. Passport.
3. Non-U.S. citizens (with legal status):
   Copy of both sides of Alien Registration or Employment Authorization card, or Visa; and
   Copy of foreign passport.
4.  Non-U.S. citizens (otherwise):
   Individual Taxpayer Identification Number (ITIN) and original ITIN assignment letter from the IRS
   Supporting documentation of identity also required, e.g., Passport, or USCIS, US Military, or
   US State I.D.

Note: FCVS verification packet may provide appropriate “Seal verified” Identity documentation.

• Self-query response from the National Practitioner Data Bank (NPDB) – see enclosed “Instructions” page. The
  NPDB will send the report directly to you and you will forward the final report to the Board office;

• FORM B: ONLY if you have answered affirmatively to either of the two malpractice questions on the
  application; Also include:
  • Copy of the legal Complaint
  • Copy of the Settlement and/or filed Dismissal
• FORM C: ONLY if applying for a license by Endorsement (Endorsement is NOT reciprocity – please refer
  to the “License Description” page of your application for clarification.);
• FORM D: ONLY if applying for an unlimited license as a Resident currently in a program – you must have
  passed all steps of United States Medical Licensing Examination (USMLE) and completed at least 24 months
  of ACGME accredited progressive postgraduate training in the United States or Canada;

• Copy of American Board of Medical Specialties (ABMS) Board certification certificate(s), copy of ABMS
  Board re-certification certificate(s); Note: FCVS packet may provide a copy of your ABMS certification(s);
• If you hold “lifetime or historical” ABMS Board certification, submit a notarized statement agreeing to
  maintain your specific Board certification for the duration of your licensure in the state of Nevada;

• Proof of 4 hours bioterrorism AMA Category 1 continuing medical education (CME) relating to the medical
  consequences of an act of terrorism that involves the use of a weapon of mass destruction. Search for an online
  course “AMA Category 1 bioterrorism continuing medical education” or take a classroom course;
• Proof of 2 hours AMA Category 1 continuing medical education (CME) in clinically-based suicide prevention
  and awareness;
• Proof of 2 hours AMA Category 1 continuing medical education (CME) in the screening, brief intervention,
  and referral to treatment approach to substance use disorder.

• Once the application and criminal background investigation fee have been received, a fingerprint card and
  instructions will be mailed to you. The fingerprint card you receive from the Board contains the necessary
  account numbers required for processing. The completed card must be returned to the Board as well as the
  signed Civil Applicant Waiver (included in your application package) prior to licensure. Note: Receipt of the
  Criminal history background results will not delay licensure.