12 AAC 14.120. Certification by credentials

(a) The board will issue a certificate by credentials to practice as a direct-entry midwife to an applicant who meets the requirements of AS 08.65.070 and this section.

(b) An applicant for a certification by credentials under this section must submit

(1) a complete and notarized application on a form provided by the department;

(2) the applicable fees established in 12 AAC 02.145;

(3) an authorization from the applicant for release of the applicant's records to the department, on a form provided by the department;

(4) copies of certification in the Basic Life Support for Health Care Providers Program (BLS) and neonatal resuscitation showing that the certification is current at the time of application;

(5) verification of the applicant's licensure status sent directly to the department from each jurisdiction where the applicant holds or has ever held a license to practice midwifery; at least one verification must indicate a current license in good standing; the verifications must document that the applicant is not the subject of any unresolved complaints or any unresolved disciplinary actions and has never had a license to practice midwifery revoked;

(6) an affidavit signed by the applicant or by a state licensing agency verifying that the applicant completed a course of study and supervised clinical experience of at least one year's duration as required under AS 08.65.050 ;

(7) verification of passing the North American Registry of Midwives Examination (NARM) sent directly to the department from NARM;

(8) documentation of fulfillment of the continuing competency requirements in 12 AAC 14.420 - 12 AAC 14.430 during the two years immediately preceding the date of application;

(9) an affidavit from the applicant on a form provided by the department documenting that the applicant was the primary or assisting midwife for at least 10 births, five of which the applicant was the primary midwife, within the 24 months preceding the date of application; the affidavit must include the information required in 12 AAC 14.210(e) (1) - (8).

(c) In order to be scheduled for review by the board at its next regularly scheduled meeting, a complete application for certification and all supporting documents, including the requirements of (b) of this section, must be received by the division's Juneau office at least 30 days before the date of the next regularly scheduled meeting of the board.

History: Eff. 5/11/94, Register 130; am 4/4/2002, Register 162; am 8/19/2004, Register 171

Authority: AS 08.65.030

AS 08.65.070

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