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Before a new wallet card can be issued, you must complete the enclosed affidavit.  Your signature on this affidavit must be notarized and returned to the Board.  Upon receipt of your affidavit, processing will be initiated for the issuance of your new card.  You must submit the original affidavit form directly to the Ohio Medical Board at 77 South High Street, 17th Floor, Columbus, Ohio 43215-6127.  WE DO NOT ACCEPT COPIES OR FAXES.

Although you outlined the reason you are requesting a duplicate wallet card in your correspondence, it is necessary that you include your reason in the appropriate section on the affidavit.  The affidavit form can be downloaded here. 

If you have any other questions, please contact Debby at Debby.Jones@med.state.oh.us.

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