Renew and Terminate Special Permit

Notice of Separation Under Business and Professions Code Sections 2111, 2113, and 2168

Request for Renewal Under Business and Professions Code Sections 2111 and 2113

Please send required items to Joan Grace Cerera for the renewal request:

• Completed renewal form
• Check made out to the Medical Board of California
• Proof of completed Continuing Medical Education (CME) (Questions regarding hours or categories, see "Continuing Medical Education Requirements for Physicians Licensed by the California State Board of Medical Quality Assurance")