Board of Osteopathic Examination
Applications and Forms
- Declaration of Citizenship (PH-4183)
- Declaration of Eligibility for Expedited Licensure Process for a Military Member (PH-4279)
- Declaration of Eligibility for Expedited Licensure Process for a Spouse of a Military Member (PH-4280)
- Name and Address Change Request
- Application Instructions for Licensure Reinstatement (PH-3556)
- Instructions for Renewal Application
- Affidavit of Retirement From Practice in Tennessee (PH-3460)
► Applying for initial licensure from your professional licensing board has become a bit easier. For the past year, the Department of Health has been working on an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.
- Application Instructions for Licensure as an Osteopathic Physician (PH-3115)
- Application for a Special Training License as an Osteopathic Physician (PH-3622)
- Application for a Locum Tenens License as an Osteopathic Physician (PH-3658)
- Application for a Single Purpose License as an Osteopathic Physician (PH-3659)
- Application for a Telemedicine License (PH-3657)
- Mandatory Practitioner Profile Questionnaire for Licensed Health Care Providers (PH-3585)
- Osteopathic - Request for Duplicate License Form (PH-4059)
- Reporting of Convictions of Physicians
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 twenty 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.org.
Office Based Surgery
- Application for Office Based Surgery (PH-3964)
- Office Based Surgery Level II Unanticipated Events Report (PH-4071)