(a) A person
applying for a temporary permit for locum tenens practice must meet the
applicable requirements of
AS
08.20.163 and this section, including passing
the state chiropractic examination described in
12 AAC 16.130.
(b) An applicant applying for a temporary
permit for locum tenens practice under
AS
08.20.163(b)(1) and this
section shall submit
(1) a completed
application on a form provided by the department;
(2) the applicable fees established in
12 AAC 02.150;
(3) official college transcripts showing that
the applicant meets the education requirements of
AS
08.20.120(a)(2) - (4);
and
(4) an official grade
transcript sent directly to the department from the National Board of
Chiropractic Examiners showing that the applicant has successfully passed the
applicable national examinations described in
12 AAC 16.037.
(c) An applicant applying for a
temporary permit for locum tenens practice under
AS
08.20.163(b)(2) and this
section shall submit
(1) a completed
application on a form provided by the department;
(2) the applicable fees established in
12 AAC 02.150;
(3) an official college transcripts showing
that the applicant meets the education requirements of AS 08.20.l63(b)(2)(C)
and (D);
(4) an official grade
transcript sent directly to the department from the National Board of
Chiropractic Examiners showing that the applicant has successfully passed the
examinations described in AS 08.20.l63(b)(2)(D) and (E);
(5) verification of practice showing that the
applicant meets the requirements of
AS
08.20.163(b)(2)(B);
(6) verification of the applicant's licensure
status and complete information regarding any disciplinary action or
investigation taken or pending, sent directly to the department from all
licensing jurisdictions where the applicant holds or has ever held a
chiropractic license; and
(7) a
notarized, sworn statement by the applicant that the applicant has not been,
within the five years preceding the date of application, the subject of an
unresolved review or an adverse decision based upon a complaint, investigation,
review procedure, or disciplinary proceeding undertaken by a state,
territorial, local, or federal chiropractic licensing jurisdiction,
chiropractic society, or law enforcement agency that relates to criminal or
fraudulent activity, chiropractic malpractice, or negligent chiropractic care
and that adversely reflects on ability or competence to engage in the practice
of chiropractic or the safety or well-being of patients;
(d) An applicant applying for a temporary
permit for locum tenens practice under
AS
08.20.163 and this section shall submit
(1) a notarized, sworn statement by the
chiropractor licensed in this state for whom the applicant will substitute,
including the dates of the substitute practice and the date that the
chiropractor licensed in this state will resume practice; and
(2) a report under AS 12.62 containing
criminal history record information concerning the applicant and issued no
earlier than 90 days before the application; if a state other than this state
is the applicant's primary state of residence, or if the applicant holds or has
ever held a license in a state other than this state to practice chiropractic,
the applicant shall also submit an equivalent report issued by that other state
and issued no earlier than 90 days before the application.
