Get California Letter 2019-2025

Due Diligence Pursuant to Section 1306 of Title 16 California Code of Regulations an application shall be deemed abandoned if an applicant fails to complete the application process within 365 days from the date of written notification from the Board of the documents needed to complete the application. PTAL Information Page 2 Listed below are the minimum application and supporting materials required for an international medical school graduate to obtain a Postgraduate Training Authorization Letter PTAL. The Board will also accept a signed and dated letter of explanation. Do Not Submit - Keep For Your Records Notes/Date Sent Physician s and Surgeon s License Forms L1A-L1F Live Scan Form CA Only or Two 2 Fingerprint Cards A minimum of 491. 00 is required to submit an application for a PTAL. Refer to the Fee Schedule for details. Complete all fields answer all questions and have the application notarized. Applicants who reside in California must complete the electronic Live Scan fingerprint process. BUSINESS CONSUMER SERVICES AND HOUSING AGENCY - Department of Consumer Affairs EDMUND G. BROWN JR. Governor MEDICAL BOARD OF CALIFORNIA Licensing Program APPLICATION INFORMATION FOR A POSTGRADUATE TRAINING AUTHORIZATION LETTER PTAL A Postgraduate Training Authorization Letter PTAL allows you to seek and commence ACGME accredited training in California. MINIMUM REQUIREMENTS TO APPLY FOR A PTAL To be eligible for a Postgraduate Training Authorization Letter PTAL applicants must have received all of their medical school education from and graduated from a medical school recognized or approved by the Medical Board of California. The medical school s name must exactly match the name on the Board s list of recognized medical schools. If the documents were purged by the arresting agency and/or court a letter of explanation from these agencies is required. In addition you may submit evidence of rehabilitation. Criminal 55. Have you ever been convicted of or pled guilty or nolo contendere to ANY offense in the United States its territories or a foreign country This includes every citation infraction misdemeanor and/or felony including traffic violations. Convictions that were adjudicated in the juvenile court or convictions under California Health and Safety Code sections 11357 b c d e or section 11360 b which are two years or older should NOT be reported. Convictions that were later expunged from the record of the court or set aside pursuant to section 1203. Anatomy Otolaryngology Obstetrics and Gynecology Radiology including Radiation Safety Tropical Medicine Physiology Biochemistry Pathology Bacteriology and Immunology Ophthalmology Dermatology Embryology Histology Human Sexuality Medicine Surgery including Orthopedic Surgery Urology Psychiatry Neurology Alcoholism and Chemical Dependency Preventative Medicine including Nutrition Physical Medicine Therapeutics Neuroanatomy Child Abuse Detection and Treatment Geriatric Medicine Pediatrics Pharmacology Anesthesia Spousal Partner Abuse Detection Treatment Family Medicine Pain Management and End-of-LifeCare ONLY applicable to medical students who enrolled in medical school on or after September 1 1994 Dates of Attendance Date the applicant enrolled in medical school Any Yes response below requires a signed and dated letter of explanation by school official. 1. Did this applicant ever take a leave of absence from his/her medical education 2. Was this applicant ever placed on probation AFFIX MEDICAL SCHOOL SEAL I certify that I am the President Dean or Registrar and hereby declare under penalty of perjury under the laws of the State of California that the above statements are true and correct.