Arizona Administrative Code › Title 4 - PROFESSIONS AND OCCUPATIONS › Chapter 18 - NATUROPATHIC PHYSICIANS MEDICAL BOARD › Article 2 - LICENSES; SPECIALISTS CERTIFICATES; CONTINUING MEDICAL EDUCATION; RENEWAL › Section R4-18-208 - Reinstatement of a Retired License

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				A person may apply to reinstate a retired license to active practice, upon
				payment of the renewal fee. As a condition of reinstatement of a retired
				license, Pursuant to A.R.S. §
									32-1528,
				each applicant shall provide proof of completion of 30 hours of continuing
				medical education, and provide the board with:
1. A completed application form, provided by
				the Board that is signed, dated, and verified; which shall include the
				following information:
a. Applicant's full
				name and any former names used by the applicant;
b. Place and date of birth;
c. Social Security number;
d. Home, business, and e-mail
				addresses;
e. Home, business, and
				cell phone numbers;
f. A completed
				Arizona Statement of Citizenship and Alien Status for State Public Benefits,
				and copy of evidence;
g. The name
				of the approved naturopathic college applicant graduated from, date of
				graduation, and date of clinical training completion;
h. The dates applicant retired the
				license;
i. A list of all license
				or certificates issued or denied by any agency. Applicant must cause to have a
				document submitted directly to the Board from each agency listed, containing
				the applicant's name, date of issuance or denial, current status and whether or
				not any disciplinary actions are pending or have ever been taken;
j. Whether applicant has ever been arrested,
				charged with, convicted of, or entered into a plea of no contest to a felony or
				a misdemeanor;
k. Whether applicant
				has ever had a naturopathic medical license or certification, or any other
				health profession license or certification denied, suspended, rejected or
				revoked by any agency;
l. Whether
				applicant has ever been disciplined by any agency for any act of unprofessional
				conduct as defined in A.R.S. §
											32-1501;
m. Whether in lieu of disciplinary action,
				has applicant ever entered into a consent agreement or stipulation with a
				licensing agency;
n. Whether
				applicant currently has an open complaint or is involved in any open
				investigation in any agency or court of law, in any state or territory of the
				United States;
o. Whether applicant
				has ever had the authority to prescribe, dispense, or administer a natural
				substance, drug, or device limited, restricted, modified, denied, surrendered
				or revoked by a federal or state agency or court of law;
p. Whether applicant has ever been found
				medically incompetent;
q. Whether
				applicant has ever been a defendant in any malpractice matter that resulted in
				a settlement or judgment;
r.
				Whether applicant has a medical condition that in any way impairs or limits
				applicant's ability to practice medicine, and;
s. A detailed explanation and supporting
				documentation for each affirmative answer to questions regarding the
				applicant's background.