Board Information

• Board Members
• Mission Statement
• Meeting Dates
• Meeting Minutes
• Policies
• Rules and Statutes

Licensure

• About Licensure
• How to apply for MD Licensure
• Physician Assistants
• Change of Address Form
• License Types and Status
• License Verifications

Discipline

• About Discipline
• Adverse Licensing Actions
• Non-Disciplinary Actions
• How to File a Complaint
• Press Releases

Board Online Services

• About Online Services
• MD Online Renewals
• Complaints against Staff
• Find a Licensee
• File a complaint online

General Forms:

Change of Address Form(pdf)

If you prefer, you can also change your address, phone, or email address online by going to our renewal site at: www.maine.gov/online/doclicensing

To change your name or correct other personal information, please contact the board directly. For Contacts click here:

File a complaint online

Printable Complaint Form(pdf)

Some pages on this site are PDF files and require Adobe ® Reader® for reading. For best accessibility, click here to download the current Adobe Reader.

Note: The best method for filling out any of our PDF forms is to:
- Click on the form you want to submit .
- Click on "Save a copy of this file" icon and save a copy to your local PC.
- Open your saved copy with Adobe Reader.
- Go to "Tools" , "Typewriter" and follow the instructions to enter text anywhere on the form necessary.
- Print out a copy and mail it to the Board.
- You can also save a copy of your filled-out form for your records if you choose.

MD Forms and Applications:

If you are applying for a Permanent License:

In addition to the application below you must complete a Federation Credentials Verification Service (FCVS) application. Click here to go to the the Federation of State Medical Boards (FSMB) and then click on the Credentials Verification Service to download the application.

If you are applying for a Temporary , or Locum (Emergency) Tenens License:

Please note the following information. The fee for temporary licenses is $300.

A physician who is qualified may be granted a temporary license for a period of 6 months (1 year total), when the Board determines that this action is necessary in order to provide relief for local or national emergencies or for situations in which the number of physicians is insufficient to supply adequate medical services; or the Board may permit a physician to serve as "locum tenens" for some other physician who is then licensed to practice medicine in this State and whose license is not temporary or limited under the provisions of Title 32 Chapter 28, if the Maine physician is unable to maintain the practice because of illness of because of absence from the general locus of this physician's practice or for other reasons determined sufficient by the Board.

If you are applying for a Camp License or Renewal:

Please download the appropriate form and follow the attached instructions.

You may apply for a Reinstatement if your license has lapsed or if you have withdrawn your license within the last five years. Please download the appropriate form and follow the attached instructions.

If you have any questions regarding these applications, or if you cannot access these applications, please contact us at (207) 287-3601. Pre-printed copies are available upon request

MD Permanent License(pdf)	MD Temporary License(pdf)	MD License Reinstatement(pdf)
MD License Renewal(pdf)	MD Camp License(pdf)	MD Camp Renewal(pdf)
MD Emergency 100 day License(pdf)	MD CME Report(pdf)	Prorated CME requirements(pdf)
MD Volunteer Conversion	MD Volunteer Renewal	MD Administrative License

 

Some pages on this site are PDF files and require Adobe ® Reader® for reading. For best accessibility, click here to download the current Adobe Reader.

Note: The best method for filling out any of our PDF forms is to:
- Click on the form you want to submit .
- Click on "Save a copy of this file" icon and save a copy to your local PC.
- Open your saved copy with Adobe Reader.
- Go to "Tools" , "Typewriter" and follow the instructions to enter text anywhere on the form necessary.
- Print out a copy and mail it to the Board.
- You can also save a copy of your filled-out form for your records if you choose.

Important Credit Card Instructions:

If you choose to pay your fee with a credit card, you must provide the following information:

Type of Card (MasterCard or Visa only!):

Card Number:

Expiration Date:

Amount:

Credit Card Holder name and billing address as it appears on the card:

This information can be included with your form on a separate typewritten sheet and mailed or faxed to the Board or you can phone it in.

PA Forms and Applications:

A physician assistant (PA) is a licensed health care professional who practices medicine under the supervision of a physician. A PA provides a broad range of health care services that were traditionally performed by a doctor. Before beginning employment in Maine, a PA must be registered with a Primary Supervising Physician by completing and submitting a Form C registration. PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and in most states can write prescriptions. A PA may not prescribe Schedule II drugs in Maine without written approval from the Board of Licensure in Medicine. To apply for written approval to prescribe Schedule II drugs, See PA Schedule II Application below.

Physician assistants must work under the supervision of a physician and their duties are determined by the supervising physician. However, PAs may be the principal care providers in places where a physician is present for only 1 or 2 days each week. In such cases, the PA maintains contact with the supervising physician and other medical professionals as needed or as required by law.

PAs may be licensed by the Maine Board of Licensure in Medicine, or the Maine Board of Osteopathic Licensure depending on their supervising physician.

Chapter 2 of the Board Rules pertain to Physician Assistants. Any Physician Assistant wishing to practice in the State of Maine under the supervision of an M.D. must be familiar with these rules. A copy can be downloaded at the following link: Chapter 2 - Physician Assistants

 

PA Initial Application(pdf)	PA Renewal Application(pdf)	Form C Registration (for PA) (PDF)
PA Schedule II Application (pdf)	PA CME Report (PDF)	PA Reinstatement Instructions (PDF)
PA Plan of Supervision Template (PDF)	Prorated CME Requirements (PDF)

 

Some pages on this site are PDF files and require Adobe ® Reader® for reading. For best accessibility, click here to download the current Adobe Reader.

Note: The best method for filling out any of our PDF forms is to:
- Click on the form you want to submit .
- Click on "Save a copy of this file" icon and save a copy to your local PC.
- Open your saved copy with Adobe Reader.
- Go to "Tools" , "Typewriter" and follow the instructions to enter text anywhere on the form necessary.
- Print out a copy and mail it to the Board.
- You can also save a copy of your filled-out form for your records if you choose.

 

Important Credit Card Instructions:

If you choose to pay your fee with a credit card, you must provide the following information:

Type of Card (MasterCard or Visa only!):

Card Number:

Expiration Date:

Amount:

Credit Card Holder name and billing address as it appears on the card:

This information can be included with your form on a separate typewritten sheet and mailed or faxed to the Board or you can phone it in.

 

Maine.gov | Dept. of Professional & Financial Regulation | Board of Licensure in Medicine | Site Policies