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Document Citation:
Wis. Adm. Code Med 4.02
Header:
WISCONSIN ADMINISTRATIVE CODE
MEDICAL EXAMINING BOARD
CHAPTER MED 4 CAMP PHYSICIAN OR LOCUM TENENS LICENSE
Date:
02/18/2014
Document:
Med 4.02 Applications, credentials, and eligibility
An applicant who holds a valid license to practice medicine and surgery issued by another licensing jurisdiction of the United States or Canada may apply to the board for temporary camp physician or locum tenens license and shall submit to the board the following:
(1) A completed and verified application form supplied by the board for this purpose.
(2) A letter from a physician licensed to practice medicine and surgery in this state requesting the applicant's ser-vices, or a letter from a camp organization or other recreational facility of this state requesting the applicant's services.
(3) A verified photostatic copy of a license to practice medicine and surgery in another licensing jurisdiction of the United States or Canada issued to the applicant and verified documentary evidence of the applicant's current eligibility to practice under that license in that jurisdiction.
(4) A recent photograph of the applicant as required under s. Med 1.02 (4).
(5) A verified statement that the applicant is familiar with the state health laws and the rules of the department of health services as related to communicable diseases.
(6) The required fees made payable to the Wisconsin department of safety and professional services.
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