12 AAC 40.010. Application for license by credentials

(a) Before the board will consider issuance of a license, an applicant for licensure by credentials shall

(1) file a complete application; and

(2) if required under 12 AAC 40.055, be interviewed in accordance with AS 08.64.255 .

(b) A complete application must include the following items

(1) submitted by the applicant:

(A) a completed application on a form provided by the department, including a photograph of the applicant and the applicant's notarized signature;

(B) a completed authorization for release of records on a form provided by the department and signed by the applicant;

(D) a statement listing each hospital at which the applicant has held privileges within the five years immediately before the date that the applicant signs the application form;

(E) all required application and licensing fees;

(F) a certified true copy of the applicant's medical, osteopathy, or podiatry school diploma or certificate;

(G) verification of the applicant's post-graduate training that meets the requirements of (h) of this section;

(2) requested by the applicant from appropriate agencies and sent directly to the division office:

(A) evidence satisfactory to the board that the applicant has passed an appropriate examination as described in (c) of this section;

(B) verification of licensure from the appropriate licensing authority in each state, territory, province, or other country where the applicant holds or has ever held a license to practice medicine;

(C) original letters of verification of hospital privileges from each of the hospitals listed by the applicant as required in (1)(D) of this subsection; the letters of verification must include

(i) confirmation of the date of privileges held by the applicant;

(ii) information on any disciplinary action taken against the applicant;

(iii) any derogatory information on record about the applicant; and

(iv) any reason for which the applicant would not be readmitted to privileges in that facility;

(D) clearance from the federal Drug Enforcement Administration (DEA);

(E) clearance from the Federation of State Medical Boards or the Federation of Podiatric State Medical Boards;

(F) a Physician Profile from the American Medical Association (AMA) or American Osteopathic Association (AOA), if applicable;

(G) verification from the applicant's medical school that the applicant completed medical school and received a medical school diploma;

(H) verification of the applicant's completion of post-graduate training that meets the requirements of (h) of this section.

(c) The evidence that an applicant has passed an appropriate examination as required by (b)(2)(A) of this section must be either

(1) verification of an examination in the medical and basic science subjects as a prerequisite to licensure in a state or territory of the United States, District of Columbia, Puerto Rico, or a province or territory of Canada; or

(2) an official transcript from

(A) the Federation of State Medical Boards documenting successful passage of the FLEX exam;

(B) the National Board of Medical Examiners documenting successful passage of the NBME exam;

(C) the National Board of Osteopathic Medical Examiners documenting successful passage of the NBOME or COMLEX examination;

(D) the National Board of Medical Examiners or the Federation of State Medical Boards documenting successful passage of the United States Medical Licensing Examination (USMLE); or

(E) the National Board of Podiatric Examiners (NBPME) documenting successful passage of the NBPME or Podiatric Medical Licensing Examination for States (PMLexis) exam; or

(3) official transcripts from the appropriate administering federations or boards documenting successful passage of all segments of an acceptable examination combination in 12 AAC 40.021.

(d) Applicants are responsible for requesting transcripts and paying any fees associated with having transcripts sent directly to the board.

(e) Before the board will consider issuance of a license, an applicant must receive clearance from the National Practitioner Data Bank.

(f) If necessary, the board will require an applicant to provide additional information to verify that the applicant meets the licensing requirements in AS 08.64.250 and this chapter.

(g) The board will waive the verification of requirements set out in (b)(2)(G) and (H) of this section for an applicant who is unable to obtain those verifications due to circumstances beyond the applicant's control as determined by the board, and the board is able to satisfactorily substantiate through other means that the applicant has met those education and training requirements. The applicant must submit to the board a written request for a waiver that

(1) explains the reason for the applicant being unable to obtain those verifications; and

(2) documents that education and training requirements have been met.

(h) An applicant for licensure under this section who graduated from a medical school described in AS 08.64.200 (a)(1) or a school of osteopathy described in AS 08.64.205 (1), must submit a certified true copy of a certificate documenting successful completion of the post-graduate training required under AS 08.64.200 (a)(2) or AS 08.64.205 (2). Any other applicant must submit a certified true copy of a certificate documenting successful completion of the post-graduate training required under AS 08.64.225 (2). Training periods of less than 12 months will not be accepted. An original letter with an original signature submitted on program letterhead will be accepted in lieu of a certified true copy of a certificate if the letter is submitted directly to the board by the recognized hospital or facility.

(i) Except for a diploma written in Latin a document submitted under this section must be either written in English or accompanied by a certified English translation of that document.

History: Eff. 12/30/70, Register 36; am 5/18/85, Register 94; am 8/2/86, Register 99; am 4/10/88, Register 106; am 5/1/94, Register 130; am 6/28/97, Register 142; am 8/17/97, Register 143; am 11/7/98, Register 148; am 8/9/2000, Register 155; am 6/15/2001, Register 158; am 4/2/2004, Register 169

Authority: AS 08.64.100

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