Current through Register Vol. 30, No. 38, September 20, 2024
A. To obtain a
certificate to engage in clinical or preceptorship training, an applicant shall
submit to the Board a complete application form provided by the Board, that
allows the Board to determine if the applicant meets the requirements of A.R.S.
§
32-1524.
The application shall be verified, and include the fee listed in
R4-18-107;
B. In addition to the requirements in
subsection (A.) a naturopathic medical student who applies for a certificate to
engage in clinical training shall comply with the requirements of A.R.S. §
32-1560,
and, be attending an approved naturopathic medical school. Applicant must
arrange to have submitted directly to the Board, a letter from the chief
medical officer of the medical school verifying that the applicant will be
entering clinical training, and the anticipated starting and completion dates.
The Board may deny an application for any reason set forth in A.R.S. §
32-1501(31)
and A.R.S. §
32-1522(A)(3)
- (6);
C. Applicant must take and pass the
examination in Arizona naturopathic jurisprudence that is administered by the
Board, with a minimum score of 75%, include with the application a passport
size photograph taken within 60 days prior to application submission that is
signed on the back by the applicant, provide a legible fingerprint card,
including the DPS processing fee as specified on the application
form;
D. The application form for
clinical training entry shall include:
1.
Applicant's full name and any former names used by applicant;
2. Applicant's place and date of
birth;
3. Applicant's Social
Security number;
4. Applicant's
home and email address;
5.
Applicant's home and cell phone numbers;
6. The name and address of the approved
naturopathic college applicant is attending; name and address of clinical
training program, the date of clinical entry and the date of completion of
clinical entry;
7. The name of the
Supervising Physician and the name of the Chief Medical Officer of the Clinical
Training program;
8. Whether
applicant has ever been arrested, charged with, convicted of, or entered into a
plea of no contest to a felony or a misdemeanor;
9. 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
in any state, district or territory of the United States or another
country;
10. Whether applicant has
ever been disciplined by any agency in any state, district or territory of the
United States or another country, for any act of unprofessional conduct as
defined in A.R.S. §
32-1501;
11. Whether applicant, in lieu of
disciplinary action, has entered into a consent agreement or stipulation with a
licensing agency in any state, district or territory of the United States or
another country;
12. Whether
applicant currently has an open complaint or is involved in any open
investigation in any agency or court of law, in any state, district or
territory of the United States or another country;
13. 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, district or territory of
the United States or another country;
14. Whether applicant has ever been found
medically incompetent;
15. Whether
applicant has ever been a defendant in any malpractice matter that resulted in
a settlement or judgment;
16.
Whether applicant has a medical condition, that in any way, impairs or limits
applicant's ability to practice medicine;
17. A detailed explanation and supporting
documentation for each affirmative answer to questions regarding the
applicant's background, and;
18. A
completed Arizona Statement of Citizenship and Alien Status for State Public
Benefits, and copy of evidence;
E.In addition to
the requirements in subsection (A.), an applicant for a certificate to engage
in a preceptorship training program shall comply with the requirements of
A.R.S. §
32-1561
and arrange to have submitted directly to the Board, an official transcript
from the approved naturopathic medical school from which the applicant
graduated;
F. Applicant must, take
and pass the examination in Arizona naturopathic jurisprudence that is
administered by the Board with a minimum score of 75%, include with the
application, a passport size photograph taken within 60 days prior to
application submission that is signed on the back by the applicant, provide a
legible fingerprint card, including the DPS processing fee as specified on the
application form;
G. The
application form for preceptorship training shall include:
1. Applicant's full name and any former names
used by applicant;
2. Applicant's
place and date of birth;
3.
Applicant's Social Security number;
4. Applicant's home and email
address
5. Applicant's home and
cell phone numbers;
6. The name,
address, and medical license number of the Supervising Physician, designated
Supervising Physician, if any, and Chief Medical Officer;
7. Attestation signed by the Supervising
Physician declaring they have read and understand A.R.S. § 32-1561 and
R4-18-108,
and agree to be the Supervising physician of record;
8. Whether applicant has ever been arrested,
charged with, convicted of, or entered into a plea of no contest to a felony or
a misdemeanor;
9. 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 state, district or territory or the United States or another
country;
10. Whether applicant has
ever been disciplined by any agency in any state, district or territory of the
United States or another country, for any act of unprofessional conduct as
defined in A.R.S. § 32-1501;
11. Whether applicant, in lieu of
disciplinary action by any agency, in any state, district or territory of the
United States or another country, has entered into a consent agreement or
stipulation with a licensing agency;
12. Whether applicant currently has an open
complaint or is involved in any open investigation in any agency or court of
law, in any state, district or territory of the United States or another
country;
13. 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, district
or territory of the United States, or another country;
14. Whether applicant has ever been found
medically incompetent;
15. Whether
applicant has ever been a defendant in any malpractice matter that resulted in
a settlement or judgment;
16.
Whether applicant has a medical condition, that in any way, impairs or limits
applicant's ability to practice medicine;
17. A detailed explanation and supporting
documentation for each affirmative answer to questions regarding the
applicant's background; and
18. A
completed Arizona Statement of Citizenship and Alien Status for State Public
Benefits, and copy of evidence.
