Wisconsin Department of Safety and Professional Services
Health & Business Renewal Application
Application Status Query
Instructions:
Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.
Please verify the checklist information below, including your address. If your address has changed, please
e-mail
your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.
As of
:
07/02/2018
Application#
:
650337
Name
:
Falcucci, Octavio A
Profession
:
Medicine and Surgery, MD
Address
:
Hummelstown, PA
Application Status
:
(Permanent license issued)
Requirements Not Met:
Description
Status
Comments (Please note, not all requirements will include comments)
Requirements Met:
Description
Status
Comments (Please note, not all requirements will include comments)
Application Fee
Met
$75
Application Complete
Met
All activities and practice accounted for
Met
Certification of Legal Status Completed
Met
Electronic affidavit via OLAS
Met
Authorization and Waiver, signed (Form #571)
Met
USMLE (Step 1, Step 2, Step 3)
Met
FCVS JR
ECFMG certification
Met
Electronic Document Uploaded on 6/15/2018 5:12:11 PM;
Physicians Profile Data Report from AOA or AMA
Met
report date 6/19/18
-jt
Physician Data Center Practitioner Profile Report (Form #1445)
Met
report date 6/15/18 JR
Medical Education Verification Form (Form #2164)
Met
FCVS JR
Certificate of Post-Graduate Training (Form #2165)
Met
6/21/18: rec'd form FCVS:
Ravenswood 7/93-6/94;
Boston Univ 7/94-6/97;
Univ of FL 7/97-6/98;
Icahn 9/98-8/99
JR
Received Hospital, Facility and Employer Verification Forms
Met
6/25/18:
Penn State 10/08-6/18
-jt
Verification of state license(s) directly from State Board office(s)
Met
6/21/18: PA;
JR
-----
6/19/18: Rec'd: VA -jt
National Practitioner Data Bank Report/Self-query response
Met
report date 6/15/18 JR
Oral Exam to be determined after application is completed
Met
7/2/18: complete --lf;
-----
6/25/18: File sent to Board for review, please allow at least 15 – 20 business days for review;
------
6/21/18: When file is complete it will be sent for review & at that time you will need to allow at least 15 -20 business days for the review.
Social Security Number
Met
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