Ariz. Admin. Code § 4-16-202

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

Section R4-16-202 - Application and Reapplication for Pro Bono Registration

A. An applicant for a pro bono registration to practice medicine for a maximum of 60 days in a calendar year in Arizona shall submit the following information on an application form available on request from the Board and on the Board's web site:

1. Applicant's full name, social security number, business and home addresses, primary e-mail address, and business and home telephone numbers;

2. List of all states, U.S. territories, and provinces in which the applicant is or has been licensed to practice medicine;

3. A statement verifying that the applicant:

a. Agrees to render all medical services without accepting a fee or salary; or

b. Agrees to perform only initial or follow-up examinations at no cost to the patient or the patient's family through a charitable organization,

B. In addition to the application form required under subsection (A), an applicant for a pro bono registration to practice medicine shall submit documentation listed under A.R.S. § 41-1080(A) showing that the applicant's presence in the U.S. is authorized under federal law.

C. An applicant may make application for a pro bono registration annually. A previously registered applicant may apply for a pro bono registration by submitting the following information on an application form available on request from the Board and on the Board's web site:

1. Applicant's full name, home address and telephone number, and primary e-mail address;

2. Number of previous pro bono registration;

3. Name of each state, U.S. territory, and province in which the applicant holds an active medical license;

4. A statement whether since issuance of the last pro bono registration:

a. Any disciplinary action has been taken against the applicant, and

b. Any unresolved complaints are currently pending against the applicant with any state board; and

5. If the document submitted under R4-16-202(B) was a limited form of work authorization issued by the federal government, evidence that the applicant's presence in the U.S. continues to be authorized under federal law.

Ariz. Admin. Code § R4-16-202

Adopted effective September 22, 1995 (Supp. 95-3). Amended by final rulemaking at 8 A.A.R. 2319, effective May 9, 2002 (Supp. 02-2). Former Section R4-16-202 recodified to R4-16-302; New Section R4-16-202 recodified from R4-16-107at 11 A.A.R. 1283, effective March 25, 2005 (Supp. 05-1). Amended by exempt rulemaking at 21 A.A.R. 2630, effective 10/15/2015.