Arizona Administrative Code › Title 4 - PROFESSIONS AND OCCUPATIONS › Chapter 21 - BOARD OF OPTOMETRY › Article 2 - LICENSING PROVISIONS › Section R4-21-205 - License Renewal

Current through Register Vol. 30, No. 28, July 12, 2024
A. To continue
				practicing the profession of optometry in Arizona, a licensee shall renew the
				licensee's license and certificate of special qualification, if applicable, on
				or before the date on which the license and certificate expire. Timely renewal
				is a licensee's responsibility. As a courtesy, the Board may provide a licensee
				with notice that the licensee's license is going to expire. Failure to obtain
				notice of the need to renew is not good cause for failing to renew.
B. To renew a license and, if applicable,
				certificate of special qualification, a licensee shall submit to the Board a
				license renewal application and provide the following information:
1. Whether the licensee wants to renew the
				licensee's license and, if applicable, certificate of special
				qualification;
2. The licensee's
				current public mailing address, telephone and fax numbers;
3. The licensee's current residential
				address, e-mail address, and residential or mobile telephone numbers;
4. The licensee's current permanent and
				temporary practice addresses and telephone and fax numbers;
5. A statement of whether the licensee:
a. Has practiced the profession of optometry
				within the last two years;
b. Has
				been denied the right to take an examination for optometric licensure by any
				state or jurisdiction within the preceding two years and if so, the name of the
				state or jurisdiction, date, and reason for the denial;
c. Has been denied an optometric license or
				renewal in any state or jurisdiction within the preceding two years and if so,
				the name of the state or jurisdiction, date, and reason for denial;
d. Has had a license or certificate of
				registration to practice the profession of optometry suspended or revoked by
				any optometric regulatory agency within the preceding two years and if so, the
				name of the optometric regulatory agency, date, action taken, reason for the
				action, and current status;
e. Has
				had disciplinary action instituted against the licensee by any optometric
				regulatory agency within the preceding two years and if so, the name of the
				optometric regulatory agency, date, nature of the disciplinary action, reason
				for the disciplinary action, and current status;
f. Has had an investigation conducted within
				the preceding two years or has an investigation pending by an optometric
				regulatory agency of any state or jurisdiction and if so, name of the
				optometric regulatory agency and the state or jurisdiction, date, reason for
				the investigation, and current status;
g. Has been convicted of, pled guilty or no
				contest to, or entered into diversion in lieu of prosecution for any criminal
				offense in any jurisdiction of the United States or foreign country within the
				preceding two years, and if so, the name of the jurisdiction, date, offense
				charged, offense for which convicted, pled guilty, or no contest, and current
				status;
h. Is currently, or has
				been addicted to narcotic substances or habitually abused alcohol within the
				preceding two years. If so, dates during which the addiction or abuse occurred,
				steps taken to address the addiction or abuse, current statu , and a statement
				as to why the addiction or abuse does not amount to unprofessional conduct.
i. Has
				had the authority to prescribe, dispense, or administer pharmaceutical agents
				limited, restricted, modified, denied, surrendered, or revoked by a federal or
				state agency within the preceding two years and if so, name of agency taking
				action, nature of action taken, date, reason for action, and current status;
				and
j. Is in compliance with
				the provisions of A.R.S. §
											32-3211;
6. The following information about
				each approved Continuing Education course attended by the licensee during the
				preceding two years:
a. Name of Continuing
				Education provider,
b.
				Title,
c. COPE course
				identification number, if any
d. Date(s) of
				attendance, and
e. Number of hours of
				attendance; and
7. The
				licensee's dated signature affirming that the information provided is true and
				correct.