Wisconsin Administrative Code
Medical Examining Board
Chapter Med 26 - Military Medical Personnel
Section Med 26.05 - Documentation of training and experience

(a) The name of the administering facility at which the military medical personnel will be providing delegated clinical care pursuant to this chapter.

(b) An identification of the military medical personnel as either an army medic, a navy corpsman, a coastguard corpsman, or an air force aerospace medical technician, and the individual's dates of service in such role.

(c) The date of the military medical personnel's date of honorable or regular discharge from military service. Such date must be within the 12 months prior to the date the memorandum of understanding is signed by the military medical personnel and the administering facility.

(d) A description of the medical training and experience the individual received as an army medic, a navy corpsman, a coastguard corpsman, or an air force aerospace medical technician.

(e) A reasonable timeline, consistent with s. 440.077 (3) (c), Stats., that describes the actions the military medical personnel intends to take to acquire a license under s. 441.06, 441.10, 448.04, 448.61, or 448.974, Stats., including the date by which the military medical personnel agrees to acquire the license. Except as provided in s. Med 26.06, the memorandum of understanding shall terminate one day after the date specified above or the date the military medical personnel acquires the license, whichever is earlier. A reasonable timeline shall be subject to approval by the board or it's designee. Such approval may include consideration of any of the following factors:

(f) An attestation by the military medical personnel that they will not accept a delegation of practice authority under this chapter to perform a clinical act if his or her training and experience as a military medical personnel did not include that clinical act.

(g) An attestation by the administering facility that it has a written policy governing clinical practice by registered military medical personnel, and that policy is shared with the military medical personnel subject to the memorandum of understanding and those licensed supervising practitioners authorized to delegate clinical acts to the individual.

(h) An attestation by the administering facility that the administering facility to the best of the administering facility's knowledge and with a reasonable degree of certainty, all of the information in the memorandum of understanding is true.

(i) The memorandum of understanding is signed and dated by the military medical personnel and an authorized representative of the administering facility.

Note: The memorandum of understanding form can be located on the department's website at http://dsps.wi.gov.