Ariz. Admin. Code § R9-25-403 - Application Requirements for EMCT Certification or Paramedic Endorsement for Providing Critical Care Services (Authorized by A.R.S. Sections 36-2202(A)(2), (A)(3), (A)(4), and (H) and 36-2204(1) and (6))
A. An individual may apply for initial EMCT certification if:
1. The individual
is at least 18 years of age;
2. The individual complies with the requirements in A.R.S. §
41-1080;
3. The individual is not ineligible under R9-25-402; and
4. One of the following applies to the individual:
a. The individual has not
previously applied for certification from the Department or has withdrawn an application for certification;
b. An application for certification submitted by the individual was denied by the Department two or more years
before the present date;
c. Except as provided in R9-25-404(A)(2) or (3), the individual's certification
as an EMCT is expired;
d. The individual's certification as an EMCT was revoked by the Department five or
more years before the present date; or
e. The individual has current certification as an EMCT and is
applying for certification at a different classification level of EMCT.
B. An
applicant for initial EMCT certification shall submit to the Department an application, including:
1. The following
information in a Department-provided format:
a. The applicant's name, address, telephone number, email address,
date of birth, gender, and Social Security number;
b. The level of EMCT certification being
requested;
c. Responses to questions addressing the applicant's criminal history according to
R9-25-402(A)(1) through (3) and (C);
d. Whether the applicant has within the five years before the date
of the application had:
i. EMCT certification or recertification revoked in Arizona;
ii. Certification, recertification, or licensure at an EMCT classification level revoked, suspended, or voluntarily
surrendered in another state or jurisdiction; or
iii. Certification or licensure as a health
professional, as defined in A.R.S. §
36-3201, revoked, suspended, or voluntarily surrendered in Arizona or in another state or
jurisdiction;
e. Attestation that all information required as part of the application has been
submitted and is true and accurate; and
f. The applicant's signature or electronic signature and date of
signature;
2. For each affirmative response to a question addressing the applicant's criminal
history required in subsection (B)(1)(c), a detailed explanation in a Department-provided format and supporting documentation;
3. For each affirmative response to subsection (B)(1)(d), a detailed explanation in a Department-provided format
and supporting documentation;
4. If applicable, a copy of certification, recertification, or licensure at
an EMCT classification level issued to the applicant in another state or jurisdiction;
5. Documentation
for the applicant that complies with A.R.S. §
41-1080;
a. U.S. passport, current or expired;
b. Birth certificate;
c. Naturalization documents; or
d. Documentation of legal resident alien
status; and
6. One of the following:
b.a. Documentation of current registration in a national
certification organization at the applicable or higher level of EMCT classification;
a. Either:
i. A certificate of completion showing that within two
years before the date of the application, the applicant completed statewide standardized training; and
ii. A statewide standardized certification test;
or
b. Documentation of
completion of training and testing by a branch of the U.S. Armed Forces that is comparable to requirements of a national certification organization
for the applicable or higher level of EMCT classification; or
c. A certificate of completion showing
that, within the two years before the date of the application, the applicant completed statewide standardized training and a statewide standardized
certification test.
C. A Paramedic applying for endorsement for providing critical
care services shall submit to the Department an application, including:
1. The following information in a
Department-provided format:
a. The applicant's name, address, telephone number, email address, date of birth, and
Social Security number;
b. The applicant's current certification number as a Paramedic;
c. Attestation that all information required as part of the application has been submitted and is true and
accurate; and
d. The applicant's signature or electronic signature and date of signature; and
2. Documentation of passing a critical care examination given by a national certification organization.
Notes
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