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Fifth Pathway Verification Form (Form #4) For State Board Use OnlyApplicant: DO NOT COMPLETE THIS FORM IF YOU ARE USING CVS. CVS verifies this data for you. If you are not using CVS, complete Section

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How to fill out medicalboardiowagovdocumentfifth-pathwayfifth pathway verification form

01

Download the Fifth Pathway Verification Form from the medicalboardiowa.gov website.

02

Fill in your personal information, including your name, contact information, and date of birth.

03

Provide details about your medical education, including the names of the medical schools you attended and the dates of your medical education.

04

Indicate whether you have successfully completed the Fifth Pathway Program and provide relevant documentation if applicable.

05

If you did not complete the Fifth Pathway Program, provide an explanation and any supporting documentation for any alternative pathway you followed to obtain your medical education.

06

Sign and date the form.

07

Submit the completed form to the Iowa Medical Board for verification.

Who needs medicalboardiowagovdocumentfifth-pathwayfifth pathway verification form?

01

Anyone who has completed the Fifth Pathway Program and wishes to have their medical education verified by the Iowa Medical Board needs to fill out the Fifth Pathway Verification Form.

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What is medicalboardiowagovdocumentfifth-pathwayfifth pathway verification form?

The fifth pathway verification form is a document used by the Iowa Medical Board to verify the eligibility of individuals who are applying for medical licensure through the fifth pathway.

Who is required to file medicalboardiowagovdocumentfifth-pathwayfifth pathway verification form?

Individuals who did not graduate from an accredited medical school, but completed at least two years of postgraduate training in the U.S. are required to file the fifth pathway verification form.

How to fill out medicalboardiowagovdocumentfifth-pathwayfifth pathway verification form?

The form must be completed with information about the applicant's medical education, postgraduate training, clinical experience, and references. It must also be signed by the program director of the postgraduate training program.

What is the purpose of medicalboardiowagovdocumentfifth-pathwayfifth pathway verification form?

The purpose of the fifth pathway verification form is to confirm that individuals who did not attend an accredited medical school have met the necessary requirements for medical licensure in Iowa.

What information must be reported on medicalboardiowagovdocumentfifth-pathwayfifth pathway verification form?

The form requires information about the applicant's medical education, postgraduate training, clinical experience, and references.

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