Physicians must apply through the Portfolio Evaluation Process (PEP). Applicants may choose either the Entry Level or Special Circumstances category. In either case, in addition to any hospital experience the applicant must document attendance, as the primary midwife, at 10 out-of-hospital births (Three of these births must include a full course of continuity of care.) These 10 out-of-hospital births must be under the direct supervision of a CPM or licensed midwife. Applicants who received training in another country must have transcripts verified by International Credentialing Associates (ICA), Inc., 7245 Bryan Dairy Rd, Bryan Dairy Business Park II, Largo, FL 33777.