(b) A complete application
for a license by examination must meet the requirements of
AS
08.64.200,
08.64.205,
08.64.209, or 08.64.225 and
include the following documents
(1) submitted
by the applicant:
(A) a completed application
on a form provided by the department, including a photograph of the applicant
and the applicant's notarized signature;
(B) a completed authorization for release of
records on a form provided by the department and signed by the
applicant;
(C) a true and correct
attestation listing each hospital at which the applicant has held privileges
within the five years immediately before the date the applicant signs the
application form, and a disclosure of any disciplinary action against the
applicant by any hospital or other health care facility at any time, including
whether
(i) the applicant's employment or
privileges were restricted, terminated, or investigated; or
(ii) the applicant is currently under
investigation for a complaint or accusation regarding the applicant's
practice;
(D) all
application and licensing fees required under 12 AAC 02.250;
(E) an attestation that that the applicant
has completed education in pain management and opioid use and addiction; if the
applicant does not currently hold a valid federal Drug Enforcement
Administration registration number, verification will be waived until the
applicant applies for a valid registration number;
(F) verification that the applicant has
completed at least two hours of education in pain management and opioid use and
addiction earned in a Category I continuing medical education program
accredited by the American Medical Association, a Category I or II continuing
medical education program accredited by the American Osteopathic Association,
or a continuing medical education program from a provider that is approved by
the Council on Podiatric Medical Education; if the applicant does not currently
hold a valid federal Drug Enforcement Administration registration number,
verification will be waived until the applicant applies for a valid
registration number;
(G) a true and
correct attestation whether the applicant has been the subject of a revoked or
restricted DEA registration;
(2) submitted directly to the division office
upon the applicant's request:
(A) clearance
from the Federation of State Medical Boards or the Federation of Podiatric
State Medical Boards;
(B)
verification from the applicant's medical school that the applicant completed
medical school and received a medical school diploma;
(C) verification of completion of
post-graduate training from the facility where the applicant completed the
internship or residency program, if applicable; training periods of less than
12 months in a program will not be accepted;
(D) for foreign medical graduates,
verification from the Educational Commission for Foreign Medical Graduates
(ECFMG) of successful ECFMG certification, or a certified true copy of the
applicant's certificate from the Educational Commission for Foreign Medical
Graduates (ECFMG).
(E) repealed
3/25/2020;
(F) verification from
the applicant's medical school that the applicant completed medical school and
received a medical school diploma;
(G) if applicable, verification of completion
of post-graduate training from the facility where the applicant completed the
internship or residency program; training periods of less than 12 months in a
program will not be accepted;
(H)
for foreign medical graduates, verification from the Educational Commission for
Foreign Medical Graduates (ECFMG) of successful ECFMG certification, or a
certified true copy of the applicant's certificate from the Educational
Commission For Foreign Medical Graduates (ECFMG).
(c) After passing the written
examination an applicant must be interviewed in accordance with
AS
08.64.255 if the board determines that, under
12 AAC 40.055, an interview is
required before the board will consider issuance of a license.
(d) Before the board will consider issuance
of a license, an applicant
(1) shall provide
for official examination results to be sent to the department directly from the
examination agency; and
(2) must
receive clearance from the National Practitioner Data Bank.
(e) If necessary, the board will
require an applicant to provide additional information to verify that the
applicant meets the licensing requirements in
(1)AS
08.64.200,
08.64.205,
08.64.209, or 08.64.225;
and
(2) this chapter.
(f) Except for a diploma written
in Latin a document submitted under this section must be either written in
English or accompanied by a certified English translation of that
document.
(g) Notwithstanding
(b)(2) of this section, an applicant for licensure by examination may submit
the credentials verification documents through the Federation Credentials
Verification Service of the Federation of State Medical Boards of the United
States, Inc., sent directly to the department from FCVS.
Information on the verification process described in 12 AAC 40.015(g) may be obtained from the Federation of State Medical Boards of
the United States, Inc., P.O. Box 619850, Dallas, TX 75261-9850; telephone:
(817) 868-4000; website at www.fsmb.org.
