Ohio Code § 3702.72

§ 3702.72.

(A) A primary care physician who will not have an outstanding obligation for medical

service to the federal government, a state, or other entity at the time of participation

in the physician loan repayment program and meets one of the following requirements

may apply for participation in the physician loan repayment program: (1) The primary care physician is enrolled in the final year of an accredited program

required for board certification in a primary care specialty. (2) The primary care physician is enrolled in the final year of a fellowship program

in a primary care specialty. (3) The primary care physician holds a valid license to practice medicine and surgery

or osteopathic medicine and surgery issued under Chapter 4731. of the Revised Code. (B) An application for participation in the physician loan repayment program shall be

submitted to the director of health on a form that the director shall prescribe.  The information required to be submitted with an application includes the following: (1) The applicant's name, permanent address or address at which the applicant is currently

residing if different from the permanent address, and telephone number; (2) The applicant's primary care specialty or specialties; (3) The medical school or osteopathic medical school the applicant attended, the dates

of attendance, and verification of attendance; (4) The facility or institution where the applicant's medical residency program was completed

or is being performed, and, if completed, the date of completion; (5) If applicable, the facility or institution where the applicant's fellowship was completed

or is being performed, and, if completed, the date of completion; (6) A summary and verification of the educational expenses for which the applicant seeks

reimbursement under the program; (7) Verification of the applicant's authorization under Chapter 4731. of the Revised

Code to practice medicine and surgery or osteopathic medicine and surgery; (8) Verification of the applicant's United States citizenship or status as a legal alien.