N.H. Admin. Code § Gen 403.07 - Supporting Materials
The materials supporting the reinstatement application shall be as described below:
(a) On a
separate sheet, a detailed report of the relevant circumstances if any of the
answers to the questions from the reinstatement application form specified in
Ahp
601.02 provided by the genetic counseling governing
board are in the affirmative;
(b)
On a separate sheet, a statement that the reinstatement applicant has not
practiced genetic counseling in New Hampshire since the date the license
lapsed;
(c) A photocopy of the
applicant's current certificate issued by one of the following:
(1) The American Board of Genetic
Counseling;
(2) American Board of
Medical Genetics; or
(3) The
successor organization.
(d) A resume containing a chronologically
organized account of the applicant's paid or volunteer work experience in
genetic counseling for the past 10 years or completion of the academic program,
including:
(1) Each separate experience in
paid or volunteer work:
a. Serving as an
educator in genetic counseling;
b.
Serving as an administrator in genetic counseling; or
c. Contributing expertise in genetic
counseling to a board or committee;
(2) The period of each separate experience
described by the month and year it began and month and year it ended;
and
(3) The physical address of
each experience.
(e)
Unless the information is available only on a website, an official letter of
verification sent directly to the board from every jurisdiction which has
issued a license or other authorization to practice in any health care field
since the date that the license lapsed:
(1)
Stating that such license or other authorization is or was, during its period
of validity, in good standing; and
(2) Stating whether any disciplinary action
was taken against the license or other authorization to practice; and
(f) Either:
(1) A criminal history records check form and
fingerprint card, seeking both a New Hampshire and a federal records check, in
accordance with the procedure specified by the NH department of safety rules at
Saf-C 5700, operation of the central repository: criminal records, with the
required fee:
(2) If the federal
criminal history records check shows the existence of a criminal record in
another state, the applicant shall obtain a detailed criminal record check
directly from that sate and provide it to the board; or
(3) An original, not a photocopy, of a
criminal offender record report:
a. Issued by
each state where the applicant has resided or been licensed within the past 6
years, providing that such state will:
1. Send
the report to the board; or
2. To
the applicant for forwarding to the board;
b. Covering the applicant under all names and
any aliases; and
c. Dated within
the 6 months predating the application for licensure.
Notes
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