Ariz. Admin. Code § 4-16-201.1

Current through Register Vol. 30, No. 50, December 13, 2024

Section R4-16-201.1 - Application for Renewal of License

A. Under A.R.S. § 32-1430(A), an individual licensed under A.R.S. Title 32, Chapter 13, shall renew the license every other year on or before the licensee's birthday.

B. To renew a license, a licensee shall submit the following information on an application form available on request from the Board and on the Board's web site:

1. The licensee's full name, license number, business and home addresses, primary e-mail address, and business and home telephone numbers;

2. Identification of changes to medical specialties and fields of practice;

3. A statement of whether, since the time of last license issuance, the licensee:

a. Has had an application for medical licensure denied or rejected by another state or province licensing board and if so, an explanation;

b. Has had any disciplinary or rehabilitative action taken against the licensee by another licensing board, including other health professions and if so, an explanation;

c. Has had any disciplinary action, restriction, or limitation taken against the licensee by any program or health care provider and if so, an explanation;

d. Has been subject to discipline resulting in a medical license being revoked, suspended, limited, cancelled during an investigation, restricted, or voluntarily surrendered, or resulting in probation or entry into a consent agreement or stipulation and if so, an explanation;

e. Has had hospital privileges revoked, denied, suspended, or restricted and if so, an explanation (do not report if the licensee's hospital privileges were suspended due to failure to complete hospital records and reinstated after no more than 90 days);

f. Has been subjected to disciplinary action including censure, practice restriction, suspension, sanction, or removal from practice by an agency of the state or federal government and if so, an explanation;

g. Has had the authority to prescribe, dispense, or administer medications limited, restricted, modified, denied, surrendered, or revoked by a federal or state agency as a result of disciplinary or other adverse action and if so, an explanation;

h. Has been found guilty or entered into a plea of no contest to a felony, a misdemeanor involving moral turpitude, or an alcohol or drug-related offense in any state and if so, an explanation; and

i. Has failed the SPEX;

4. A statement of whether the licensee understands and complies with the medical records and recordkeeping requirements in A.R.S. §§ 32-3211 and 12-2297;

5. A statement of whether the licensee has completed at least 40 hours of CME as required under A.R.S. § 32-1434 and R4-16-102, including the hour of CME required under R4-16-102(A)(1);

6. A statement of whether the licensee requests that the license be inactivated or cancelled; and

7. A statement of whether the licensee completed a training unit prescribed by the Board regarding the requirements of A.R.S. Title 32, Chapter 13 and this Chapter.

C. Additionally, the licensee shall answer the following confidential question:

1. Whether the licensee currently has a medical condition that impairs the licensee's ability to practice medicine in a competent, ethical, and professional manner;

2. If the answer to subsection (C)(1) is yes:

a. Provide an explanation of the medical condition; and

b. If currently practicing under a monitoring agreement with a licensing board in another state, attach a copy of the monitoring agreement to the application; and

D. To renew a license, a licensee shall submit the following with the required application form:

1. If the document submitted under R4-16-201(C)(3) was a limited form of work authorization issued by the federal government, evidence that the licensee's presence in the U.S. continues to be authorized under federal law;

2. The renewal fee specified under R4-16-205 and, if applicable, the penalty fee for late renewal; and

3. An attestation that all information submitted is correct.

Ariz. Admin. Code § R4-16-201.1

Adopted by exempt rulemaking at 21 A.A.R. 2630, effective 10/15/2015. Amended by final rulemaking at 24 A.A.R. 182, effective 3/10/2018. Amended by final rulemaking at 27 A.A.R. 2907, effective 2/6/2022.