Obtaining a PTL License

I created this document to help with some tips and guidelines to obtaining your PTL

license. I found that the process was not as straightforward as I had anticipated and there

were definitely some roadblocks that popped up during the process. Hopefully this makes

things easier for you!

Tips

MBC in a timely fashion. They can reach out to people directly at the MBC and

help make sure your application gets through.

- If you are having issues with your application and/or you have not heard back

from the MBC about the status of your application within 45 days of submitting

it, you can call the following number (916) 263-2382 and explain your situation.

This should get your case escalated to a supervisor/manager and help move things

along.

Step 1: Starting the Application

• PTL1 Confidential Address: Enter your home address so the MBC can contact

you.

• PTL1 #3: Answer yes if appropriate.

• PTL2 ACGME Training Programs: Verify your start date and expected end date

with your program.

• PTL2 #4-10: Do be honest as any false answer will delay or prevent licensing.

Use the Explanation For Application Question (Form EXP) for each Yes

response.

• PTL3 #11-19: Do be honest as any false answer will delay or prevent licensing.

Use the Explanation For Application Question (Form EXP) for each Yes

3) Complete the following forms which must be mailed in to the MBC or sent via

MBC secure portal (which GME has access to)

• PTL5: Requires a recent 2x2 or 2x3 inch photograph & the page which must be

notarized. (Passport photos are acceptable) Mail it directly to the MBC or hand

into GME to be sent via the MBC secure portal.

• LiveScan fingerprint form

(http://www.mbc.ca.gov/Forms/Applicants/live_scan.pdf). Be sure to have two

copies ready when you go to get fingerprinted. One copy is for the MBC, one

copy is for you. Submit it along with PTL5 to the MBC or hand into GME to be

medical school. Form MED can be found online at the MBC website

https://www.mbc.ca.gov/Download/Forms/ps-med.pdf

2) Request that your medical school send the completed form directly to the MBC

along with an official copy of your transcript and a certified copy of your diploma.

Your medical school should be very familiar with the process. Contact your school’s

Registrar’s office for assistance.

3) The MBC does accept online transcripts from ClearingHouse provided your medical

school uses this service. You will have to email the transcript to [email protected].

1) Certificate of Completion of ACGME/RCPSC/CFPC Postgraduate Training, Form

PTA-PTB is necessary only if there is prior postgraduate training. Have your

current/previous programs complete and submit directly to the MBC.

2) Submit a request to have your official USMLE scores (I, II…) sent directly to the

MBC: http://www.usmle.org/transcripts. You will need proof of passing all three parts

when applying for a Physician and Surgeon License after your completion of 36 months

of postgraduate training.

2) The closest place to the hospital to get fingerprinted is the UPS store in the Town and

Country Village: 855 El Camino Real Ste 13A, Palo Alto, CA 94301

3) To get your PTL5 form notarized, you can bring it to the GME office and they will

notarize it for you. However, if COVID is still happening and the GME office is not

open, you can get your form notarized through an online service:

https://www.notarycam.com/

4) Notary reimbursement:

https://med.stanford.edu/content/dam/sm/gme/housestaff/forms/Reimbursement%20Form

%20v7.pdf

Correcting Deficiencies

- Once your application has been submitted and initially processed, you will receive

notification within 45 days from the MBC as to whether your application has been

approved for final review or whether you have deficiencies that need to be corrected first

- Be sure to correct those deficiencies ASAP in order to expedite the final review of your

application for approval of PTL license.

- If you are in a program with research years built into it (e.g 7 year general surgery

program) and are told that you need a letter of explanation about why you are

1) Once you obtain your license, be sure to email your license copy to Perteek so she can

add it to MedHub

2) Apply for DEA license so you can e-prescribe

• Once you have received your MBC license number, you can apply for DEA

number:

https://apps.deadiversion.usdoj.gov/webforms2/spring/main?execution=e2s1

• Once you get your DEA certificate, send a copy to Perteek and she can upload it

to Medhub for you

• Ask your program coordinator or Marcy Kulakow for EPIC e-prescribe access

20Form%20v7.pdf