Licensee Services and Forms Download

Address Changes: Please keep your information current by submitting changes to your home, practice, or physical address at renewal time.

Malpractice Reporting: The law requires that ANY malpractice claim of ANY kind SHALL be reported regardless. This includes ANY and all malpractice claims that you may have been named in even if you are not the primary defendant. PLEASE note, pursuant to law, all reports of malpractice claims are a matter of public record.

Please print this form and complete the required fields. Mail the completed form to the Board office. When there is a status change or resolution of the malpractice claim, you must complete an additional form and send in to the board. This form may be used at any other time through out the year if you need to report any malpractice issues. Per NRS 633.527 - An Osteopathic Physician shall report any action for malpractice against them within 45 days. As well, all actions are deemed public knowledge. (Please see actual statute for full explanation)

Downloads: You may download renewal and malpractice reporting forms.
2018 DO / PA Renewal Form
PA Notification/Collaborating Agreement
Physician Assistant Inactive Affidavit
APRN Collaborating Agreement
Malpractice Claim Reporting Form
Affidavit for Inactive Status Form
Affidavit for Expired Status Form
Affidavit for Reinstatement Form
Annual Office Based Procedures Reporting Form
Address Change Form
Board Certified Specialty Update Form
Credit Card Form
License Verification to Other States

New Application Forms:

Affidavit for Child Support
Affidavit And Authorization For Release of Information
Affidavit of Moral and Professional Character
Medical Malpractice/Professional Liability Claims Information
Notification to Nevada State Board of Osteopathic Medicine of Supervision of Physician Assistant
Hospital Privileges Verification
Licensure Verification Form
Social Security Number Document
Credit Card Form
Additional Entries - Post Graduate
Additional Entries - Examinations
Additional Entries - State Licensure
Additional Entries - Other Licensure
Additional Entries - College/University Education
Additional Entries - Medical School
Additional Entries - Employment History