Section 12 AAC 40.015 - Application for license by examination(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;(C) a true and correct attestation listing each hospital at which the applicant has held privileges within the five years immediately before the date the applicant signs the application form, and a disclosure of any disciplinary action against the applicant by any hospital or other health care facility at any time, including whether (i) the applicant's employment or privileges were restricted, terminated, or investigated; or(ii) the applicant is currently under investigation for a complaint or accusation regarding the applicant's practice;(D) all application and licensing fees required under 12 AAC 02.250;(E) an attestation that that the applicant has completed education in pain management and opioid use and addiction; if the applicant does not currently hold a valid federal Drug Enforcement Administration registration number, verification will be waived until the applicant applies for a valid registration number;(F) verification that the applicant has completed at least two hours of education in pain management and opioid use and addiction earned in a Category I continuing medical education program accredited by the American Medical Association, a Category I or II continuing medical education program accredited by the American Osteopathic Association, or a continuing medical education program from a provider that is approved by the Council on Podiatric Medical Education; if the applicant does not currently hold a valid federal Drug Enforcement Administration registration number, verification will be waived until the applicant applies for a valid registration number;(G) a true and correct attestation whether the applicant has been the subject of a revoked or restricted DEA registration;(2) submitted directly to the division office upon the applicant's request:(A) clearance from the Federation of State Medical Boards or the Federation of Podiatric State Medical Boards;(B) verification from the applicant's medical school that the applicant completed medical school and received a medical school diploma;(C) verification of completion of post-graduate training from the facility where the applicant completed the internship or residency program, if applicable; training periods of less than 12 months in a program will not be accepted;(D) for foreign medical graduates, verification from the Educational Commission for Foreign Medical Graduates (ECFMG) of successful ECFMG certification, or 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 and received a medical school diploma;(G) if applicable, verification of completion of post-graduate training from the facility where the applicant completed the internship or residency program; training periods of less than 12 months in a program will not be accepted;(H) for foreign medical graduates, verification from the Educational Commission for Foreign Medical Graduates (ECFMG) of successful ECFMG certification, or a certified true copy of the applicant's certificate from the Educational Commission For Foreign Medical Graduates (ECFMG).(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(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.(g) Notwithstanding (b)(2) of this section, an applicant for licensure by examination may submit the credentials verification documents through the Federation Credentials Verification Service of the Federation of State Medical Boards of the United States, Inc., sent directly to the department from FCVS.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; am 3/4/2007, Register 181; am 12/21/2007, Register 184; am 8/17/2018, Register 227, October 2018; am 3/25/2020, Register 233, April 2020; em am 4/21/2020 - 8/18/2020, Register 234; am 11/16/2020, Register 236; am 8/30/2024, Register 251, October 2024Information on the verification process described in 12 AAC 40.015(g) may be obtained from the Federation of State Medical Boards of the United States, Inc., P.O. Box 619850, Dallas, TX 75261-9850; telephone: (817) 868-4000; website at www.fsmb.org.
Authority:AS 08.64.100
AS 08.64.180
AS 08.64.190
AS 08.64.205
AS 08.64.209
AS 08.64.210
AS 08.64.225
AS 08.64.240
AS 08.64.255