Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-18 - QUALIFIED ALABAMA CONTROLLED SUBSTANCES CERTIFICATE (QACSC) FOR CERTIFIED REGISTERED NURSE PRACTITIONERS (CRNP) AND CERTIFIED NURSE MIDWIVES (CNM) › Section 540-X-18-.05.01 - Renewal Of A Qualified Alabama Controlled Substances Registration Certificate (QACSC) - Required Disclosures

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 The applicant shall disclose whether:
(a)
			 Applicant's privilege for dispensing or prescribing controlled substances has
			 ever been suspended, restricted, voluntarily surrendered while under
			 investigation, revoked, or disciplined in any manner in any state or U.S.
			 territory.
(b) Applicant has ever
			 been convicted of any state or federal crime relating to any controlled
			 substance.
(c) Any Federal Drug
			 Enforcement Administration registration ever held by applicant has ever been
			 suspended, restricted, revoked or voluntarily surrendered while under
			 investigation.
(d) Applicant's
			 privileges at any hospitals have ever been suspended, restricted, revoked, or
			 disciplined in any manner for any reason related to the prescribing or
			 dispensing of controlled substances.
(e) Applicant is currently engaged in the
			 excessive use of alcohol, controlled substances, or the use of illegal drugs,
			 or receiving any therapy or treatment for alcohol or drug use, sexual boundary
			 issues or mental health issues.
1. If
			 applicant is an anonymous participant in the Alabama Board of Nursing's
			 Voluntary Disciplinary Alternative Program and is in compliance with their
			 assistance agreement, they may answer "No" to this question. Such answer for
			 this purpose will not be deemed upon certification as providing false
			 information to the Alabama Board of Medical Examiners.
2. The term "currently" as it is used in
			 paragraph (5) above does not mean on the day of, or even in the weeks or months
			 preceding the completion of the application. Rather, it means recently enough
			 so that the condition referred to may have an ongoing impact on one's
			 functioning as a Certified Registered Nurse Practitioner or Certified Nurse
			 Midwife within the last two years.
3. Applicant shall initial certifying an
			 understanding of a statement of the duty as a registrant to address any such
			 condition, which states as follows: IMPORTANT: The Board recognizes that
			 registrants encounter health conditions, including those involving mental
			 health and substance use disorders, just as their patients and other health
			 care providers do. The Board expects its registrants to address their health
			 concerns and ensure patient safety. Options include anonymously selfreferring
			 to the Alabama Board of Nursing's Voluntary Disciplinary Alternative Program
			 (334-293-5200), an advocacy organization dedicated to improving the health and
			 wellness of nursing professionals in a confidential manner. The failure to
			 adequately address a health condition, where the registrant is unable to
			 practice medicine with reasonable skill and safety to patients, can result in
			 the Board taking action against the QACSC.
(f) Any disciplinary action has been taken or
			 is pending against applicant with the Alabama Board of Nursing or any other
			 licensing authority of any state, territory, or country.