State Medical Board Applications & Forms Initial Applications Review the FAQs page for important information about applying for licensure and practicing in the State of Alaska. Physician (MD, DO, DPM) MD/DO Online application for licensure Filed through your MyAlaska account. Also allows for email notifications about your application status. Uniform Application (UA) for initial licensure Offered through the Federation of State Medical Boards (FSMB) to benefit physicians applying for licensure in multiple states. FSMB customer service: Phone 800-793-7939. Email: ua@fsmb.org MD/DO Paper Application for Initial Licensure #08-4105, Revised 03/16/2023Application for Physician Licensure in Alaska Application for Resident Permit #08-4022, Revised 03/11/2022 For resident physicians who wish to serve all or a portion of their residency training in Alaska. Application for Podiatrist License #08-4109, Revised 05/18/2023 Includes application for temporary permit. Application for Locum Tenens Permit #08-4021, Revised 03/11/2022 For medical and osteopathic physicians. Application for Physician Courtesy License #08-4288, Revised 03/16/2023 Physician license for specific, limited purposes. Physician Assistant Physician Assistant - Certified, Online Application Filed through your MyAlaska account. Also allows for email notifications about your application status. The online application is available for certified physician assistants ONLY. To apply as a graduate physician assistant, utilize the paper application form linked below. Physician Assistant, Paper Application #08-4226, Revised 03/16/2023 Application for certified or graduate physician assistants. Physician Assistant Collaborative Plan #08-4226(d), Revised 03/16/2023 Addendum to Collaborative Plan #08-4226(e), Revised 03/16/2023 Authorization for Prescriptive Authority/Physician Assistant – Certified #08-0017, Revised 09/15/2007 Periodic Record of Assessment/Physician Assistant – Certified #08-4348, Revised 05/2012 Renewal Applications Paper application for MD, DO, DPM license renewal Medical License (MD/DO/DPM) License Renewal Application, #08-0077, Revised 10/26/2022 Paper application for PA license renewal Physician Assistant License Renewal Application, #08-0079, Revised 12/06/2022 Online Applications available through MYAlaska Prior to renewal, check out our License Renewal Prep guide. Review the FAQ Page for important information about CME requirements for renewals, including the legislative requirement for education in pain management and opioid use and addiction. Miscellaneous Forms Online License Verification via VeriDoc Use if you need a verification of your Alaska physician license sent to another state medical board. The fee is $30. The verification will be sent via computer - transfer of information occurs immediately. Periodic Record of Assessment/Physician Assistant - Certified #08-4348, Revised 05/2012 For collaborating physicians Medical Board Mandated Reporting Form #08-4864, New 08/15/2023 Request for Examination and Board Action History Report Physician-Pharmacist Cooperative Practice Agreement #08-4410, Revised 09/28/2023 Authorization for Prescriptive Authority/Physician Assistant - Certified #08-0017, Revised 09/15/07 IHS Provider State Licensure Exemption#08-4853, New 05/04/2022 Request for Expedited Review #08-4664, Revised 04/17/2023 Division forms may be found in the CBPL Quick links, located in the sidebar to the right. Licensing Staff Contact Information Physicians and Physician Assistants whose last name begins with the letters A through J may contact: Licensing Examiner: Jason Kaeser Phone: (907) 465-2781 Email: jason.kaeser@alaska.gov Physicians and Physician Assistants whose last name begins with the letters K through Q may contact: Licensing Examiner: Jacob Olsen Phone: (907) 465-2566 Email: jacob.olsen@alaska.gov Physicians and Physician Assistants whose last name begins with the letters R through Z may contact: Alisa Perkins Phone: (907) 465-1077 Email: alisa.perkins@alaska.gov Medical licensing general contact: Email: medicalboard@alaska.gov