This outlines the appropriate requirements for obtaining a faculty limited license. The Board reserves the right to make whatever additional demands on the applicant for licensure the Board deems appropriate at the time. Below is a summary of what is listed in the rules of Chapter 32 of the North Carolina Administrative Code.

Submit all materials to:
North Carolina Medical Board, PO Box 20007, Raleigh, NC 27619 (919.326.1100), or
North Carolina Medical Board, 1203 Front Street, Raleigh, NC 27609
Please do not submit photocopies or facsimilies unless specifically permitted.

Section .0800 - Medical School Faculty License | 21 NCAC 32 B .0801 - Definition of Practice
The license for Medical School Faculty limits the practice of its holder to the confines of the physician’s employment as a member of the medical faculty at one of the following North Carolina medical schools:

• Duke University School of Medicine;
• University of North Carolina at Chapel Hill School of Medicine;
• East Carolina University School of Medicine; and
• Wake Forest University School of Medicine

This license will not be used to engage in a practice outside the realm of the medical school.

History Note: Authority G.S. 90-12; Eff. October 1, 1993.

1. Completed application form.

• Circle the correct answer for all questions.
• Provide detailed explanations for affirmative answers.
• A claim form must be completed for each malpractice suit or settlement. Attach a photocopy of plaintiff’s complaint and settlement orders for each incident.
• Sign applicant’s oath and have signature NOTARIZED. Make sure the original application form is submitted to the Board.
• If your name has changed at any time during your life, you will need to list your prior names and submit a copy of legal documentation (marriage certificate, divorce decree, adoption papers, etc.) supporting the name change.

2. Attach a photograph taken within the past year to the applicant’s oath. Complete the form and have the form notazrized.

• Transcripts - If you attended one medical school for more or less than the standard four years, OR if you attended more than one medical school, you must submit original medical school transcript(s), translated into English, if applicable.

3. Verification of medical education: Forward form to medical school for completion.

4. Letter from the Dean of the medical school or his appointed representative, confirming that the applicant has received a full-time appointment at the medical school as either a lecturer, assistant professor, associate professor, or full professor. This letter must be an original, include the dates of the appointment, the Dean or his appointed representative’s original signature, addressed to the NC Medical Board.

5. Two recommendations must be from physicians using the enclosed Physician Reference Forms. Recommendations cannot be from a relative. These forms must be sent from the reference source directly to the NC Medical Board.

6. You must secure a report from each state regarding status of licensure. All licenses, active and/or inactive, must be verified. Most licensing agencies charge a fee for this service. The verifications should be sent directly to the NC medical Board.

• If you have ever been licensed in Connecticut, you must send the consent for release of confidential disciplinary records form along with the NC license verification form to the Connecticut Department of Public Health. If you have never been licensed in Connecticut, disregard the form.

7. Applicants must submit a National Practitioner Data Bank (NPDB) and Healthcare Integrity and Protection Data Bank (HIPDB) report as part of their application.  The NPDB and HIPDB report must be dated within sixty (60) days of submission of your application to the NCMB. You will need to send the notarized “self -query” form to the National Practitioner Data Bank address.  The NPDB will send you e-mail notification when the report is available for online viewing.  You can access this report online from their web site. You will need to print this report and send to the NCMB. You can e-mail a copy of the report to license@ncmedboard.org. http://www.npdb-hipdb.hrsa.gov/welcomesq.html.

8.  Applicants must request an AMA Physician Profile from the AMA.  Visit the AMA’s web site (https://profiles.ama-assn.org/amaprofiles) to request a profile be mailed directly to the NCMB office from the AMA. If you are a DO, visit the American Osteopathic Association’s web site (https://www.doprofiles.org) to request a physician profile be sent directly to the NCMB from the AOA.  This should be done in addition to the AMA profile.

9. Applicants must request a Board Action Databank Inquiry form from the Federation of State Medical Boards of the US. (http://www.fsmb.org/fpdc_data_inquiry.html)

10. Applicants must submit two completed fingerprint cards for the purpose of conducting a criminal background check. When possible, have different officials complete each card. It is recommended you have your local law enforcement office complete the fingerprinting. An application is not considered complete until results of the background check have been received. Expect a minimum of 8 weeks for the report to be received. Since rejections are common, the SBI has suggested that applicants use lotion or witch hazel on their hands before being fingerprinted. Fingerprint cards are submitted for processing twice a week. The SBI has suggested that using live scan when available may be a more reliable choice. When using live scan, prints must be printed on fingerprint cards and be submitted to the NC Medical Board. They cannot be submitted electronically. See detailed instructions for completing cards. E-mail fpc@ncmedboard.org to request a set of fingerprint cards. A set contains 2 fingerprint cards.

11. When all application materials have been received, your file will be forwarded to a staff member for quality assurance review. If the quality assurance review is complete and no additional information is needed, you file will be forwarded to a board member for review to determine whether you will be required to appear for a personal interview. Upon receipt of the Board members’ decision, your license will be issued if a personal interview is not required.

12. If a physician has been away from clinical practice 2 years or longer, they may be required to develop a reentry plan as part of the license application. It is the responsibility of the applicant to be prepared to present a program of re-training or supervision that will establish proof of competency in their chosen area or medicine. Applicants in this category will be required to appear for a personal interview.