Ariz. Admin. Code § R4-17-206 - License Renewal

A. To renew a license, a licensee shall submit a completed application to the Board that includes:

1. An application form that contains the licensee's:

a. First, last, and middle names;

b. Arizona license number;

c. Office, mailing, e-mail, and home addresses;

d. Office, mobile, and home telephone numbers;

2. A questionnaire that includes answers to the following since the last renewal date:

a. Whether the licensee has had an application for a certificate, registration, or license refused or denied by any licensing authority, and if so, an explanation;

b. Whether the licensee has had the privilege of taking an examination for a professional license refused or denied by any entity, and if so, an explanation;

c. Whether the licensee has voluntarily surrendered a health care professional license, and if so, an explanation;

d. Whether the licensee has had a health professional license suspended or revoked, or whether any other disciplinary action has been taken against a health professional license held by the licensee, and if so, an explanation;

e. Whether the licensee has had any action taken against the applicant's privileges, including termination, resignation, or withdrawal by a health care institution or health profession regulatory authority, and if so, an explanation;

f. Whether the licensee has had a federal or state regulatory authority take any action against the license's authority to prescribe, dispense, or administer controlled substances including revocation, suspension, or denial, or whether the applicant surrendered the authority in lieu of any of these actions, and if so, an explanation;

g. Whether the licensee has been charged with, convicted of, pleaded guilty to, or entered into a plea of no contest to a felony or misdemeanor involving moral turpitude or an alcohol- or drug-related offense in any state, or has been pardoned or had a record expunged or vacated, and if so, an explanation;

h. Whether the licensee has been court-martialed or discharged other than honorably from any component of the uniformed services of the United States, and if so, an explanation;

i. Whether the licensee has been involuntarily terminated from a health professional position with any city, county, state, or federal government, and if so, an explanation;

j. Whether the licensee has been convicted of insurance fraud or a state or the federal government has sanctioned or taken any action against the licensee, such as suspension or removal from practice, and if so, an explanation;

3. Consistent with the Board's statutory authority, other information the Board may deem necessary to evaluate the licensee fully;

4. A dated and sworn statement by the licensee verifying that during the past biennial license period, the licensee completed at least 40 hours of Category I continuing medical education as required by A.R.S. § 32-2523;

5. The fee required in R4-17-204;

6. A confidential questionnaire that includes answers to the following:

a. Whether the licensee currently has a medical condition that impairs the licensee's judgment or ability to practice medicine in a competent, ethical, and professional manner;

b. If the answer to subsection (A)(6)(a) is yes:

i. Provide an explanation of the medical condition; and

ii. If currently practicing under a monitoring agreement with a licensing board in another state, attach a copy of the monitoring agreement to the application; and

c. A copy of any public or confidential agreement or order relating to the use, disorder, or condition, issued by a licensing agency or health care institution since the last renewal, if applicable; and

7. If the document submitted under R4-17-203(B)(1) was a limited form of work authorization issued by the federal government, evidence that the licensee's presence in the U.S. continues to be authorized under federal law.

B. Under A.R.S. § 32-2523(A), the Board shall randomly select at least 10 percent of renewal applications submitted by licensees who are not currently certified by a national certification organization to verify compliance with the continuing medical education requirement specified in R4-17-205(A). If selected, a licensee shall submit to the Board documents that verify compliance with the continuing medical education requirement.

Notes

Ariz. Admin. Code § R4-17-206

Adopted effective April 22, 1998 (Supp. 98-2). Amended by final rulemaking at 18 A.A.R. 2123, effective October 7, 2012 (Supp. 12-3). Amended by final rulemaking at 22 A.A.R. 3700, effective 2/6/2017. Amended by final rulemaking at 28 A.A.R. 1757, effective 9/4/2022.