Arizona Administrative Code
Title 9 - HEALTH SERVICES
Chapter 16 - DEPARTMENT OF HEALTH SERVICES - OCCUPATIONAL LICENSING
Article 8 - COMMUNITY HEALTH WORKERS
Section R9-16-809 - Changes Affecting a Certificate; Request for a Duplicate Certificate

Universal Citation: AZ Admin Code R 9-16-809

Current through Register Vol. 30, No. 12, March 22, 2024

A. A certified CHW shall submit to the Department a notice in a Department-provided format within 30 calendar days after the effective date of a change in:

1. The certified CHW's home address, telephone number, or e-mail address, including the new home address, telephone number, or e-mail address; and

2. The certified CHW's name, including a copy of one of the following with the certified CHW's new name:
a. Marriage certificate,

b. Divorce decree, or

c. Other legal document establishing the certified CHW's new name.

B. A certificate holder may obtain a duplicate certificate by submitting to the Department a written request for a duplicate certificate in a Department-provided format that includes:

1. The certified CHW's name and address,

2. The certified CHW's certification number and expiration date,

3. The certified CHW's signature and date of signature, and

4. A duplicate certificate fee specified in R9-16-810.

Disclaimer: These regulations may not be the most recent version. Arizona may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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