Current through Register No. 40, October 3, 2024
(a) A license to practice psychology shall be
renewed for 2 years upon approval by the board of a complete application
submitted prior to the date of license expiration.
(b) Any licensee wishing to renew an existing
license shall submit a "Renewal Application Form" provided by the board with
the following:
(1) Name and license
number;
(2) Residence address and
telephone number(s);
(3) Business
address and telephone number(s);
(4) The name of an employer, if any;
(5) An e-mail address, if any;
(6) A statement indicating whether the
applicant is actively engaged in the practice of psychology in New
Hampshire;
(7) Disclosure, and
explanation where applicable, of the following information regarding the
previous 2-year period:
a. Whether any
malpractice claim has been made against the applicant, regardless of whether a
lawsuit was filed in relation to the claim;
b. If the applicant has any complaints
pending against a license or certificate in any state or jurisdiction,
excluding NH;
c. If the applicant
has been found civilly liable for professional misconduct or committing an
ethical violation, or has entered into a settlement agreement to resolve a
misconduct or ethical complaint with any state or provincial regulatory
authority or board outside of NH since the last renewal of the NH license;
d. If the applicant has
voluntarily surrendered a license to practice psychology in lieu of
disciplinary action;
e. If the
applicant has been convicted of a felony or misdemeanor;
f. If the applicant knows of any reason why
he or she might be unable to practice psychology in a competent and ethical
manner;
g. If the applicant has a
plan in place to manage his or her clinical records in the event of death or
incapacity; and
h. Whether the
applicant is actively practicing a mental health discipline regulated by the
board;
(8) On the board
provided "Attestation to CEU's and Collaboration" form, the applicant's
notarized dated signature, license number, and printed name, which shall verify
that the applicant is in compliance with the continuing education requirements
of Psyc 402.01 and the interdisciplinary collaboration activities required
pursuant to Psyc 403;
(9) The
applicant' signature which acknowledges:
a.
That the provision of false information in the application is a basis for
disciplinary action by the board; and
b. That the information and documentation
provided in the application is true, accurate, complete, and unaltered;
and
(10) The date the
applicant signed the application.
(c) The filing fee shall be as established by
RSA 310-A:1-e (a), I.
(d) Pursuant
to
RSA
126-A:5, XVIII-a(a) and
RSA
329-B:10-a, licensees shall complete, as part
of their renewal application, the applicable New Hampshire division of public
health service's health professions survey issued by the state office of rural
health and primary care, department of health and human services, pursuant to
He-C 801.
(e) The board shall
provide licensees with the opportunity to opt out of the survey. Written notice
of the opt-out opportunity shall be provided with the renewal application. The
opt out form shall be available on the NH state office of rural health and
primary care website at
https://www.dhhs.nh.gov/dphs/bchs/rhpc/data-center.htm
and the board's website at
https://www.oplc.nh.gov/psychologists/licensure-survey.htm.
(f) Licensees choosing to opt-out of the
survey shall complete and submit the "New Hampshire Health Professions Survey
Opt-Out Form," effective April 2019, to the state office of rural health and
primary care, department of health and human services, via one of the
following:
(1) Mail;
(2) Email; or
(3) Fax.
(g) Information contained in the opt-out
forms shall be kept confidential in the same accord with the survey form
results, pursuant to
RSA
126-A:5XVIII-a.(c).
