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Order Reports
Federation of Podiatric Medical Boards
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Order Reports
Order Reports
Select Who You Are Below:
Podiatrist
YOU are, or represent, a PODIATRIST and want to order a report to be sent to a destination.
Organization
YOU represent an ORGANIZATION (ex: hospital, CVO) and want to order a report on a podiatrist to be sent to your organization.
Order Reports - Podiatrists
Podiatrists
can request that the Federation of Podiatric Medical Boards send their
Part I/II/III (PMLexis) Score
and/or
Disciplinary
reports to State Boards, Residencies, Fellowships, VAs, etc. only.
Reports
cannot
be sent to individuals. After completing the form, you will have the option to
pay online by credit card
-or-
print out a form to mail in with a check
.
(No User Account Required)
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Order Reports (Podiatrists)
Order Reports - Organizations
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FPMB Disciplinary Reports
are
FAST
and
EASY
to Order
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Online Ordering
Available 24/7/365
FPMB processes most reports within 1 business day
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Electronic Delivery
Reports are sent electronically
Reports are in PDF format
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First-Class Support
Friendly, knowledgeable support available via phone & email
Results-focused assistance to meet your needs
Organizations must have an online account to place orders.
To create an account, please download, complete and return the
Website User Account Request Form
.
Organizations
(managed care, CVOs, etc.) can request that the Federation of Podiatric Medical Boards send
Disciplinary
reports on podiatrists via our fast, secure and convenient online system. After completing the form, you will have the option to
pay online by credit card
-or-
print out a form to mail in with a check
. Processed reports are returned to organizations via secure electronic delivery.
Frequently Asked Questions
How are reports sent to Organizations?
Reports are sent via electronic delivery.
How long is turnaround time?
The FPMB typically processes report requests within one business day.
How will you know that the FPMB
received
your order?
Organizations will receive an email receipt that also serves as confirmation that your order has been received.
How will you know that the FPMB
processed
your order?
Organizations will receive an email notification when the FPMB has processed your order.
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Order Reports (Organizations)
Order Reports - Organizations
Contact Information
Please verify that all contact and address information below is accurate.
If any of this information is incorrect, do
not
proceed with this order and contact the FPMB at
fpmb@fpmb.org
.
ELECTRONIC DELIVERY
(for email notification to download completed reports)
Name
Title
Email Address
BILLING INFORMATION
(if paying by credit card; receipt is sent to this email address)
Name
Company
Address
City/State/ZIP Code
Phone Number
Email Address
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Order Information
Indicates a Required Field
How many PROVIDERS are in this order?
REQUIRED: How many PROVIDERS are in this order?
PROVIDER
#1
:
FIRST Name
REQUIRED: First Name #1
Middle Name
LAST Name
REQUIRED: Last Name #1
Maiden/Alternate Name
Date of Birth
REQUIRED: Date of Birth #1
INVALID: Date of Birth #1 [format: 1/1/1950]
(format: 1/1/1950)
Social Security Number
REQUIRED: Social Security Number #1
INVALID: Social Security Number #1 [format: 123-45-6789]
(format: 123-45-6789)
PROVIDER
#2
:
FIRST Name
REQUIRED: First Name #2
Middle Name
LAST Name
REQUIRED: Last Name #2
Maiden/Alternate Name
Date of Birth
REQUIRED: Date of Birth #2
INVALID: Date of Birth #2 [format: 1/1/1950]
(format: 1/1/1950)
Social Security Number
REQUIRED: Social Security Number #2
INVALID: Social Security Number #2 [format: 123-45-6789]
(format: 123-45-6789)
PROVIDER
#3
:
FIRST Name
REQUIRED: First Name #3
Middle Name
LAST Name
REQUIRED: Last Name #3
Maiden/Alternate Name
Date of Birth
REQUIRED: Date of Birth #3
INVALID: Date of Birth #3 [format: 1/1/1950]
(format: 1/1/1950)
Social Security Number
REQUIRED: Social Security Number #3
INVALID: Social Security Number #3 [format: 123-45-6789]
(format: 123-45-6789)
PROVIDER
#4
:
FIRST Name
REQUIRED: First Name #4
Middle Name
LAST Name
REQUIRED: Last Name #4
Maiden/Alternate Name
Date of Birth
REQUIRED: Date of Birth #4
INVALID: Date of Birth #4 [format: 1/1/1950]
(format: 1/1/1950)
Social Security Number
REQUIRED: Social Security Number #4
INVALID: Social Security Number #4 [format: 123-45-6789]
(format: 123-45-6789)
PROVIDER
#5
:
FIRST Name
REQUIRED: First Name #5
Middle Name
LAST Name
REQUIRED: Last Name #5
Maiden/Alternate Name
Date of Birth
REQUIRED: Date of Birth #5
INVALID: Date of Birth #5 [format: 1/1/1950]
(format: 1/1/1950)
Social Security Number
REQUIRED: Social Security Number #5
INVALID: Social Security Number #5 [format: 123-45-6789]
(format: 123-45-6789)
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Review and Place Order
INSTRUCTIONS
12/12/2024 6:23 AM ET
Print a copy of this order by clicking the "PRINT ORDER" button below.
Make check payable to the
"Federation of Podiatric Medical Boards"
for the TOTAL amount displayed below.
Send the check and a copy of this request to:
Federation of Podiatric Medical Boards
12116 Flag Harbor Drive
Germantown, MD 20874-1979
Do
not
send by Registered, Certified or Express Mail -- this will
delay
processing your request.
**You will receive an email notification when your order has been processed.**
Please allow up to ten (10) business days from the date that payment is received for your order to be processed.
PAYMENT STATUS: ACCEPTED
12/12/2024 6:23 AM ET
Print a copy of this order as a receipt by clicking the "PRINT ORDER" button below.
**You will receive an email notification when your order has been processed.**
Please allow up to ten (10) business days for your order to be processed.
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FPMB Disciplinary Reports
are
FAST
and
EASY
to Order
workspace_premium
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Online Ordering
speed
Electronic Delivery
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First-Class Support
NAME
TITLE
Phone Number
Email Address
(for delivery)
ORDER ID
Provider 1
Provider 2
Provider 3
Provider 4
Provider 5
TOTAL
ALL ORDERS ARE FINAL. NO REFUNDS WILL BE PROVIDED.
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Pay by
Check
(print & mail)
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Pay by
Credit Card
(faster processing)
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Print Order
INSTRUCTIONS
In the
Order Summary
section, verify the
Order Amount
and
Description
.
In the
Credit Card Information
section, enter your credit card (Visa or MasterCard) information.
In the
Billing Information
, verify that your name and contact information are correct.
Click the
Process Payment
button.
NOTE:
To pay by check, click the
Review Order
button below.
ALL ORDERS ARE FINAL. NO REFUNDS WILL BE PROVIDED.
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Review Order
We are sorry, but your payment was declined for the following reason:
[Code
]:
INSTRUCTIONS
If you have a problem with one credit card, you may wish to try a different card.
Click the "Credit Card (try again)" button below to try again.
To pay by check, click the "Pay By Check" button below.
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Pay by
Check
(print & mail)
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Pay by
Credit Card
(try again)
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Print Order
Order Reports - Podiatrists