12 AAC 40.015. Application for license by examination

(a) Repealed 6/28/97.

(b) A complete application for a license by examination must meet the requirements of AS 08.64.200 , 08.64.205, 08.64.209, or 08.64.225 and include the following documents

(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 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) a certified true copy of each of the applicant's post-graduate training program certificates;

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

(A) original letters of verification of hospital privileges from each of the hospitals listed by the applicant 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;

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

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

(E) for foreign medical graduates, a certified true copy of the applicant's certificate from the Educational Commission for Foreign Medical Graduates (ECFMG);

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

(G) verification of completion of the first year of post-graduate training from the facility where the applicant completed the first year of internship or residency program.

(c) After passing the written examination an applicant must be interviewed in accordance with AS 08.64.255 if the board determines that, under 12 AAC 40.055, an interview is required before the board will consider issuance of a license.

(d) Before the board will consider issuance of a license, an applicant

(1) shall provide for official examination results to be sent to the department directly from the examination agency; and

(2) must receive clearance from the National Practitioner Data Bank.

(e) If necessary, the board will require an applicant to provide additional information to verify that the applicant meets the licensing requirements in

(1) AS 08.64.200 , 08.64.205, 08.64.209, or 08.64.225; and

(2) this chapter.

(f) 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. 7/29/83, Register 87; am 3/30/84, Register 89; am 4/10/88, Register 106; am 6/28/97, Register 142; am 8/17/97, Register 143; am 6/15/2001, Register 158; am 4/2/2004, Register 169

Authority: AS 08.64.100

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