Direct Online Certification SubmissionDOCS PortalThe Medical Board of California’s (Board) Direct Online Certification Submission (DOCS) portal allows medical schools and postgraduate training programs to electronically submit primary source verification documents securely and efficiently to the Board for a physician’s and surgeon’s or postgraduate training license application.

DOCS Fast Facts • Medical schools and postgraduate

training programs submit electronic documents effortlessly

• Immediate receipt of documents • It’s quick and easy to register• No medical school or postgraduate

training seals required

Register for the DOCS Portal

STEP 1Submit DOCS Portal Registration

Form to the Board

STEP 2The Board creates an account

for authorized users

STEP 3Upload documents electronically through

DOCS Portal

The DOCS Portal Registration Form is required for all medical schools and postgraduate training programs that wish to submit primary source verification documents electronically to the Board. DOCS

Portal registration forms are located on the Board’s website or by emailing DOCS@mbc.ca.gov.

MEDICALO F C A L I F O R N I A

BOARD2005 Evergreen Street, Suite 120Sacramento, CA 95815

CONTACT(916) 263 2382WWW.MBC.CA.GOV/FORMSDOCS@MBC.CA.GOV

FOLLOW@MedboardOfCA@MedicalBoardCA@MedboardOfCA

Medical Board of California Direct Online Certification Submission (DOCS) Portal Registration Form

Licensing Program 2005 Evergreen Street, Suite 1200

Sacramento, CA 95815-5401 Phone: (916) 263-2382

Fax: (916) 263-2487 www.mbc.ca.gov

This form is intended for use by medical schools and residency programs to register authorized users to submit documents to the Medical Board of California (Board) electronically through the DOCS Portal. Check One: Medical School Postgraduate Training Program Medical School Name / Postgraduate Training Facility Name

AUTHORIZED USER INFORMATION Name Title

Email Address Phone Number

AUTHORIZED PROGRAM INFORMATION (Postgraduate Training Programs Only)

1. Program Name 10-digit ACGME Number

2. Program Name 10-digit ACGME Number

3. Program Name 10-digit ACGME Number

If you have more than three programs, please attach additional information on a separate sheet

THIS SECTION MUST BE COMPLETED BY: DEAN OF MEDICAL SCHOOL, PROGRAM DIRECTOR, OR GME DIRECTOR Name Title

Email Address Phone Number

I am responsible for notifying the Board within 30 days if the designated staff noted above separates from the medical school/postgraduate training program.

Signature of Medical School Dean or Registrar / Program Director / GME Director

Date: (Original signature required)

Attention Postgraduate Training Programs: Only the GME Director or Program Director may sign this form or submit documents to the Board. If signature authority is being delegated to another person who is added above, evidence of that delegation must be attached to this form (photocopy is acceptable). Such delegation must be on official letterhead and dated within 12 months.

Medical Board of California State of California | Business, Consumer Services, and Housing Agency | Department of Consumer Affairs (Rev 09/19)

http://www.mbc.ca.gov/http:www.mbc.ca.gov

DOCS.FLier.V6DOCS Registration Formdocs-registration-form.pdfDOCS.FLier.V6DOCS Registration Form

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Check One: OffMedical School Name / Postgraduate Training Facility Name: Authorized User Name: Authorized User Title: Authorized User Email: Authorized User Phone Number: Authorized Program Name - 1: Authorized Program 10 Digit ACGME Number - 1: Authorized Program Name - 2: Authorized Program 10 Digit ACGME Number - 2: Authorized Program Name - 3: Authorized Program 10 Digit ACGME Number - 3: Dean of Medical School, Program Director, or GME Director Name: Dean of Medical School, Program Director, or GME Director Title: Dean of Medical School, Program Director, or GME Director EMail: Dean of Medical School, Program Director, or GME Director Phone: Date: