A.
A person may apply to reinstate a retired license to active practice, upon
payment of the renewal fee. As a condition of reinstatement of a retired
license, Pursuant to A.R.S. §
32-1528,
each applicant shall provide proof of completion of 30 hours of continuing
medical education, and provide the board with:
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 dates applicant retired the
license;
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;
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;
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 complete and legible fingerprint card,
including the DPS processing fee;
3. A passport size photograph taken within 60
days prior to application submission that is signed on the back by the
applicant, and;
4. The fees
specified in
R4-18-107;
5. Provide proof of completion of 30 hours of
CME taken, within the last 12 months prior to application submission. The CME
is in addition to the 30 hours required each year for license renewal, must
cover clinical application of naturopathic medical philosophy, pharmacology,
and be accredited by the Accreditation Council on Continuing Education, or
approved by any of the programs listed in
R4-18-201(B)(2)(a), (b)
and (c).