Ariz. Admin. Code § R4-8-203 - Application for Acupuncture License

A. To be licensed to practice acupuncture, an applicant shall submit an application packet to the Board that includes:

1. An application, on a form provided by the Board, that provides the following information about the applicant:

a. Name;

b. Other names by which the applicant has been known;

c. Date of birth;

d. Social Security number;

e. Home, business, and e-mail addresses;

f. Home, business, and mobile telephone numbers;

g. A statement of whether the applicant has ever been permitted by law to practice a health-care profession in this or another state, territory, or district of the United States, or another country or subdivision of another country, and if so:

i. A list of the jurisdictions in which the applicant has been permitted by law to practice a health-care profession;

ii. The number of each license;

iii. The date each license was issued;

iv. The date each license expired or expires;

v. Limitations, if any, for each license;

vi. Whether each license was granted by endorsement, examination, or another means;

h. A statement of whether the applicant is certified by the NCCAOM, and if so, whether the certification is active and current, and the dates of issuance and expiration;

i. If not certified by the NCCAOM, a statement of whether the applicant:

i. Has passed all the following NCCAOM modules: Point Location; Foundations of Oriental Medicine; Bio-medicine; and Acupuncture; or

ii. Has passed the State of California Acupuncture Licensing Examination;

j. A statement of whether the applicant has completed an acupuncture program accredited within the United States or another country or subdivision of another country, and if so, the date of program completion;

k. A statement of whether the applicant has ever had a licensing authority of another state, district, or territory of the United States, or another country or subdivision of another country, deny the applicant a license or certificate to practice acupuncture, and if so, the name of the jurisdiction denying a license or certificate, date of the denial, and an explanation of the circumstances;

l. A statement of whether the applicant has ever had a licensing authority of another state, district, or territory of the United States, or another country or subdivision of another country, revoke, suspend, limit, restrict, or take any other action regarding the applicant's license or certificate to practice acupuncture, and if so, the name of the jurisdiction taking the action, the action taken, date of the action, and an explanation of the circumstances;

m. A statement of whether the applicant has ever been convicted of a crime, including driving under the influence of drugs or alcohol, other than a minor traffic offense, and if so, the name of the jurisdiction in which convicted, the nature of the crime, date of the conviction, and current status;

n. A statement of whether the applicant has ever had a claim for malpractice or a lawsuit filed against the applicant alleging professional malpractice or negligence in the practice of acupuncture, and if so, the claim or case number, date of the claim or lawsuit, the matters alleged, and whether the claim or lawsuit is still pending or the manner in which it was resolved;

o. A statement of whether the applicant has any condition that may impair the applicant's ability to practice acupuncture safely and skillfully, and if so, the nature of the condition and any accommodations necessary;

p. A statement of whether the applicant has ever resigned, voluntarily or involuntarily, from a health-care facility while under investigation, and if so, the name of the health-care facility, the date of the resignation, and an explanation of the circumstances; and

q. A statement of whether the applicant has ever had a health-care facility terminate, restrict, or take any other action regarding the applicant's employment, professional training, or privileges, and if so, the name of the health-care facility, the date of the action, and an explanation of the circumstances;

2. An official record or document that relates to the applicant's explanation of an item under subsections (A)(1)(k) through (A)(1)(q);

3. Documentation of one of the following:

a. Certification from the NCCAOM or its successor;

b. Certification by another certifying body recognized by the Board;

c. Certification as a result of passing a licensing or certifying examination in acupuncture; or

d. Authorization by law to practice acupuncture in another state, district, or territory of the United States, or another country or subdivision of another country with licensing standards substantially similar to those in this Chapter that has not been revoked;

4. Documentation of successfully completing a Board-approved clean needle technique course. A copy of the certificate of completion showing the name of the course and the date on and location at which the course was completed is acceptable documentation;

5. A 2" X 2" photograph, taken within the last year, that shows the front of the applicant's face;

6. A completed Arizona Statement of Citizenship and Alien Status for State Public Benefits, which is a form available from the Board; and

7. A complete set of fingerprints that meet the criteria of the Federal Bureau of Investigation and are taken by a law enforcement agency or other qualified entity;

8. The amount charged by the Department of Public Safety to process fingerprints for a state and federal criminal records check; and

9. The application and initial licensing fees prescribed by the Board under R4-8-106(A)(1) and (A)(2).

B. In addition to the materials required under subsection (A), an applicant shall provide evidence that the applicant completed at least 1,850 hours of training in acupuncture, including at least 800 clinical hours, by having submitted directly to the Board an official transcript from each school at which the applicant attended a Board-approved acupuncture program showing:

1. The name and address of the school,

2. The dates on which the applicant attended the school,

3. The courses and clinical training completed by the applicant,

4. The number of hours in each course or clinical training,

5. The grade or score obtained by the applicant in each course or clinical training, and

f.6. Whether the applicant received a diploma or degree from the school.

C. In addition to complying with subsections (A) and (B), an applicant shall sign, date, and have notarized an affidavit that indicates all information provided in the application packet, including any accompanying documents submitted by or on behalf of the applicant, are true, complete, and correct.

Notes

Ariz. Admin. Code § R4-8-203

New Section adopted by final rulemaking at 6 A.A.R. 2534, effective June 12, 2000 (Supp. 00-2). Amended by final rulemaking at 14 A.A.R. 690, effective April 5, 2008 (Supp. 08-1). Amended by final rulemaking at 22 A.A.R. 2175, effective 8/2/2016.