Current through Register Vol. 30, No. 38, September 20, 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;
2. A document submitted directly to the Board
by the agency by whom the applicant is licensed as a naturopathic physician
that is signed and dated by an official of the agency and that contains:
a. The applicant's name;
b. The date of issuance of the
license;
c. The current status of
the license;
d. A statement of
whether the applicant has ever been denied a license by the agency,
and;
e. A statement of whether any
disciplinary action is pending or has ever been taken against the
applicant;
3. A copy of
the applicant's complete NPLEX examination record, to be sent directly to the
Board by the North American Board of Naturopathic Examiners "NABNE") or its
successor;
4. A complete transcript
sent directly to the board from the approved school of naturopathic medicine
from which the applicant graduated. The transcript shall include the date of
graduation and the date of completion of clinical training.
5. Applicant must provide evidence of being
actively engaged, for at least three years immediately preceding the
application, in one or more of the following:
a. The active practice as a licensed doctor
of naturopathic medicine;
b.
Participation in an approved internship, preceptorship or clinical training
program in naturopathic medicine, as defined in A.R.S. §
32-1501(4), (5),
(7);
c. Participation in an approved postdoctoral
training program in naturopathic medicine, as defined in A.R.S. §
32-1501(6);
d. Active in the resident study of
naturopathic medicine at an approved school of naturopathic medicine, as
defined in A.R.S. §
32-1501(8)(a) and
(b);
6. A complete and legible fingerprint card,
including the DPS processing fee;
7. A passport size photograph taken within 60
days prior to application submission, that is signed on the back by the
applicant;
8. The fees specified in
R4-18-107;
9. Applicants who were licensed in another
state or a Canadian province before January 1, 2005, shall include evidence of
completion of additional 60 hours of continuing medical education ("CME") in
the subject of pharmaco-therapeutics. The CME must be offered, sanctioned, or
accredited by one of the organizations referenced in
R4-18-205(B)(1),
(2)(a), (b), (c) or (4)(a), (b), (c), and
include an examination. In the event the applicant cannot provide satisfactory
evidence of completion of the required pharmacotherapeutics, or the required
examinations, pursuant to A.R.S. §
32-1524(E),
and (G)(3), the applicant will have an
additional 365 days from the date the board notifies the applicant of the
deficiency, to supply satisfactory evidence of completion.
