Arizona Administrative Code › Title 4 - PROFESSIONS AND OCCUPATIONS › Chapter 18 - NATUROPATHIC PHYSICIANS MEDICAL BOARD › Article 2 - LICENSES; SPECIALISTS CERTIFICATES; CONTINUING MEDICAL EDUCATION; RENEWAL › Section R4-18-203 - License by Endorsement

Current through Register Vol. 30, No. 28, July 12, 2024
In addition to the requirements of
				  R4-18-201,
				  an applicant for licensure by endorsement shall meet the requirements of A.R.S.
				  Title 32, Chapter 14, and provide the Board:
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 date applicant took and passed the
				required NPLEX examinations of Part I; Biomedical examination, Part II;
				Clinical Science examination, Part II; Core Clinical Science Examination, and
				the Clinical Elective examinations in acupuncture, and minor surgery. The date
				applicant took and passed the examination in Arizona naturopathic jurisprudence
				that is administered by the Board;
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 in any state or territory of the United States;
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; in any state or territory of the
				United States;
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;