Ariz. Admin. Code § R4-16-203 - Application for Locum Tenens Registration

A. An applicant for a locum tenens registration to practice medicine for a maximum of 180 consecutive days in Arizona shall submit an application form available on request from the Board and on the Board's web site that provides the information required under R4-16-201(B).

B. In addition to the application form required under subsection (A), an applicant for a locum tenens registration to practice medicine shall have the the following submitted directly to the Board, electronically or in hard copy, by the primary source, ECFMG, Veridoc, or FCVS:

1. Official transcript or other authentication of graduation from a school of medicine;

2. Verification of completion of postgraduate training;

3. A statement completed by the sponsoring Arizona-licensed physician giving the reason for the request for issuance of the registration;

4. Verification of ECFMG certification if the applicant graduated from an unap-proved school of medicine; and

5. Verification of licensure from every state in which the applicant has ever held a medical license.

C. In addition to the application form required under subsection (A), an applicant for a locum tenens registration to practice medicine shall submit the following:

1. Documentation listed under A.R.S. § 41-1080(A) showing that the applicant's presence in the U.S. is authorized under federal law;

2. A full set of fingerprints and the charge specified in R4-16-205;

3. A copy of a government-issued photo identification; and

4. The fee specified under R4-16-205.

Notes

Ariz. Admin. Code § R4-16-203

Adopted effective September 22, 1995 (Supp. 95-3). Amended by final rulemaking at 8 A.A.R. 2319, effective May 9, 2002 (Supp. 02-2). Former Section R4-16-203 recodified to R4-16-303; New Section R4-16-203 recodified from R4-16-108 at 11 A.A.R. 1283, effective March 25, 2005 (Supp. 05-1). Amended by exempt rulemaking at 21 A.A.R. 2630, effective 10/15/2015.