This outlines the appropriate requirements for obtaining a special purpose license/special permit. The Board reserves the right to make whatever additional demands on the applicant for license 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.

1. Completed application form.

• Circle the correct answer for all questions and provide a detailed explanation for all affirmative answers.
• A claim form must be completed for EACH malpractice suit or settlement (photocopy as needed). Attach a photocopy of plaintiffs complaints and settlement orders for each incident.
• Attach a photograph taken within the past year to the applicant’s oath and have the form notarized.
• 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. Verification from local facility/group to participate in a learning/teaching procedure giving details stating the name of the local facility/group where the procedure(s) will be performed, length of time of the procedure(s), type of procedure, what the procedure(s) will include and the name of the physician responsible for overseeing the procedure(s).

3. You must have verification of a full, unrestricted license mailed directly to the Board from one licensing jurisdiction. Most licensing agencies charge a fee for this service.

• If you are submitting verification of a Connecticut license as part of this application, you must send the Connecticut release form along with the NC license verification form to the Connecticut Department of Public Health.

4. Applicants must request a Board Action Databank Inquiry form from the Federation of State Medical Boards of the U.S. Visit the Federation’s Web site at and click on Credentialing/Data Services. Go to Physician Data Center home page to download the Board Action Databank Inquiry form. This form will not be returned to you, but mailed directly to the NCMB office from the Federation.

5. 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.  .  A set contains 2 fingerprint cards.

6. 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. If the quality assurance review is complete and no additional information is needed, your file will be forwarded to a Board member for review to determine whether you will be required to appear for a personal interview. You will be notified regarding the Board member’s decision.

Registration - North Carolina law requires licensed physicians to register with the Board within 30 days of their birth date, every year, no matter when the license is issued. A renewal fee is required.