30 Miss. Code. R. 2001-15-100
On or before June 30th of each year, as a part of the licensure renewal process, the Board must be provided, on the form designated by the Board, the following information concerning each licensee and the clinic they work in before renewals may be processed:
1. Clinic name and physical address
2. Clinic mailing address
3. Telephone
4. Fax
5. E-mail address
6. List all licensed Chiropractors
7. List all Chiropractic Assistants
8. List all Radiological
Technologists
9. List all
Unlicensed Graduate Chiropractors
10. When did the unlicensed graduate
chiropractor start working in the clinic?
11. What licenses, certifications or permits
does the unlicensed graduate chiropractor hold?
12. What tasks does the unlicensed
chiropractor perform in the clinic?
13. Are all licensed chiropractors in the
clinic familiar with and in compliance with the advertising restrictions of
State law cited as Mississippi Code Ann. Section
73-6-25(1)(b)
and Board rule 5.1 ? If not, please explain.
14. Are all licensed chiropractors current
with their annual 12 hours of continuing education? (Must included 3 hours of
risk management) If not, please explain.
15. Are all Radiological Technologists
current with their annual 6 hours of continuing education? If not, please
explain.
16. Are all Chiropractic
Assistants current with their annual 6 hours of continuing education? If not,
please explain.
17. List all other
personnel in clinic
18. Please send
copies of all yellow page advertisements.
19. Signature of Owner of Clinic and
date
20. Signature of other staff,
title and date
Notes
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