PMQ1
Primary medical qualification query form
Please complete this form in full. If you do not provide us with all the required details and evidence listed in Section 1
then your enquiry will be closed.
If you need more space, please continue on the supplementary information page at the end of this form.
Section 1: Document checklist (We will NOT proceed unless we have ALL
documents listed that are applicable in your case)
We need copies of all the documents listed below to deal with your enquiry. If you do not
send them to us along with the completed form (or tell us that you have send them to us
already) we will close your enquiry.
You must send a complete and accurate translation of every document that is not in English,
along with the document in its original language.
We calculate the duration of your course by the number of clock hours you have completed.
A clock hour is defined as the time spent at medical school in lectures and completing
laboratory work. In calculating clock hours we include time spent completing practical work as
part of clinical rotations and, if relevant, you pre-graduate internship. We do not include selfdirected study, distance learning or semesters, exams or years that you have had to repeat.
Copy of your primary medical qualification degree certificate
Full transcripts for each university where you have undertaken medical studies
Letter from your AWARDING body confirming:
a) the standard length of course in years;
b) the standard length of the course in clock hours (not credit hours);
c) the number of years and clock hours that you personally completed of that course
Evidence of your clinical rotations or pre-graduate internship (please do not submit any postgraduate internship evidence), including:
a) Dates of your clinical rotations/pre-graduate internship rotations
b) Number of clock hours completed in each clinical rotation/pre-graduate rotation
c) Location of each clinical rotation/pre-graduate rotation
Study in a country other than AWARDING body country – please send us the following
additional evidence:
a) Evidence of clock hours completed in each different country
b) Reason for study in more than one country
Transfer students – please send us the following additional evidence:
a) Evidence from your AWARDING body of credits transferred from each previous
university
b) Evidence of clock hours spent at each different university
c) A letter from your awarding body confirming the reasons for your transfer into their
course
d) Letters from each institution where you previously studied for your PMQ confirming
the reasons for your transfer and whether or not you failed the course or were
awarded an alternative qualification
Distance Learning – please send us the following additional evidence:
a) Evidence from your awarding body of the hours of study undertaken by distance
learning
b) Explanation of how you carried out distance learning (self-directed learning, internet or
online etc)
Section 2: your name and GMC reference number
GMC reference number
Click here to enter text.
Family name or surname
Click here to enter text.
First name
Click here to enter text.
(you may not have a GMC reference number)
Section 3: your primary medical qualification
Title of your medical qualification
Click here to enter text.
Please tell us the dates of your primary medical studies
Start date
Enter date
(dd/mm/yyyy)
End date
Enter date
(dd/mm/yyyy)
Is your awarding body currently listed in the Avicenna or IMED Directory?
Year of
award
yyyy.
Please select.
Section 4: The name and address details of the institution that awarded your primary medical
qualification (this is usually the university that your medical school is affiliated to)
Name
Click here to enter text.
Country
Click here to enter text.
Full address
Click here to enter text.
Phone number
Click here to enter text.
Fax number
Click here to enter text.
Website address
Click here to enter text.
Contact email
Click here to enter text.
Section 5: The name and address details of the medical school campus where you undertook your studies
Name of campus
Click here to enter text.
Country of campus
Click here to enter text.
Full address
Click here to enter text.
Phone number
Click here to enter text.
Fax number
Click here to enter text.
Website address
Click here to enter text.
Contact email
Click here to enter text.
This form was last updated on 19 March 2016.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
PMQ1
Page 2 of 8
Section 6: your semesters (you MUST complete this section)
Please provide full semester dates for each year of your medical studies leading to your primary medical
qualification.
If you transferred credits that counted towards your primary medical qualification from a different institution please
make it clear at which university each semester of study was undertaken.
Year
Semester
Start date
Finish date
University
1
1
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
1
2
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
1
3
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
1
4
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
2
1
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
2
2
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
2
3
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
2
4
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
3
1
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
3
2
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
3
3
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
3
4
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
4
1
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
4
2
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
4
3
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
4
4
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
5
1
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
5
2
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
5
3
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
5
4
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
6
1
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
6
2
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
6
3
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
6
4
dd/mm/yyyy
dd/mm/yyyy
Click here to enter text.
Enter text.
This form was last updated on 19 March 2016.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Country
PMQ1
Page 3 of 8
Section 7: your clinical rotations (also known as clinical clerkships)
PLEASE NOTE: THIS IS NOT YOUR INTERNSHIP
Please provide full dates and details of the hospitals where you undertook the clinical section of your primary medical
qualification (also known as clinical rotations/clinical clerkships)
Rotation type
Hospital
Country
Start date
Finish date
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
Enter text.
Enter text.
Enter text.
Enter date dd/mm/yyyy
Enter date dd/mm/yyyy
This form was last updated on 19 March 2016.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
PMQ1
Page 4 of 8
Section 8: your transferred credits (if applicable)
Did you transfer any credits from any other institutions that counted towards your medical
qualification?
Please select.
If yes please give full details about the university you transferred from in this section, if no please go to section 6.
Name of university
Enter text.
Country of university
Enter text.
Full address
Enter text.
Phone number
Enter text.
Fax number
Enter text.
Website address
Enter text.
Contact email
Enter text.
If you transferred credits from more than one university that counted towards your medical qualification please use the
supplementary evidence section at the end of this form to record the additional universities.
Section 9: your distance learning (if applicable)
Did you undertake any of your studies by distance learning? This includes online, by
correspondence, using virtual classrooms and lectures delivered over the internet (including in real
time).
Please select.
If yes please tell us about your distance learning in this section, if no please go to section 7.
Which country were you based in when you carried out your distance learning?
Enter text.
How many hours of distance learning have you completed?
Enter text.
Module
Credits awarded for this
module
1
Enter text.
Enter text.
2
Enter text.
Enter text.
3
Enter text.
Enter text.
4
Enter text.
Enter text.
If you have carried out more than four modules by distance learning please use the supplementary page at the end of
this form to give us the names of the modules and the number of credits awarded for each.
This form was last updated on 19 March 2016.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
PMQ1
Page 5 of 8
Section 10: your other periods of medical study
Have you undertaken medical studies at any other universities that did not count towards your
medical qualification?
This includes all other medical studies where credits awarded by the institution were not accepted
for transfer by the institution which awarded your overseas medical qualification.
Please select.
If yes please provide details of each university, including the dates of your study there, in this section.
1
University name
Enter text.
Country
Enter text.
Full address
Enter text.
Phone number
Enter text.
Website address
Enter text.
Contact email
Enter text.
Start date
2
University name
Enter date dd/mm/yyyy
Enter text.
Full address
Enter text.
Phone number
Enter text.
Website address
Enter text.
Contact email
Enter text.
Start date
University name
End date
Enter text.
Enter date dd/mm/yyyy
Enter text.
Country
3
Fax number
Enter date dd/mm/yyyy
Fax number
End date
Enter text.
Enter date dd/mm/yyyy
Enter text.
Country
Enter text.
Full address
Enter text.
Phone number
Enter text.
Website address
Enter text.
Contact email
Enter text.
Start date
Enter date dd/mm/yyyy
Fax number
End date
This form was last updated on 19 March 2016.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Enter text.
Enter date dd/mm/yyyy
PMQ1
Page 6 of 8
Declaration
I confirm that the information I have provided in this form regarding my primary medical qualification is true and correct
and grant permission to the GMC and its staff to undertake any checks necessary to establish the acceptability of my
primary medical qualification.
Signature
Click here to enter text.
Print name
Click here to enter text.
This form was last updated on 19 March 2016.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Date
Enter date dd/mm/yyyy
PMQ1
Page 7 of 8
Supplementary information
Please use this page if you need more space to answer any of the questions in the form. Please state clearly which
question your answer relates to.
Click here to enter text.
This form was last updated on 19 March 2016.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
PMQ1
Page 8 of 8