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Send this to the state board you are applying to for licensure NOT to FCVS/FSMB. Applicant This is a separate form from the FCVS affidavit and release. August 2014 Federation of State Medical Boards Uniform Application for Physician State Licensure Licensure Verification UA Form 1 Applicant Complete this form as instructed in the left sidebar. Were any limitations or special requirements placed upon this individual or any other reason Fifth Pathway Verification UA Form 4 director....
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