Section 844 IAC 17-1-3 - Application requirementsAuthority: IC 25-22.5-2-7; IC 25-23.4-2-6
Affected: IC 25-22.5; IC 25-23.4
Sec. 3.
(a) An applicant for certification as a certified direct entry midwife shall file an application on a form supplied by the board and submit the fees required by section 4 of this rule.(b) In addition to the requirements of IC 25-23.4-3-1, the applicant for certification shall provide the following:(1) A notarized or certified copy of the applicant's Certified Professional Midwife credentials conferred by the North American Registry of Midwives or its successor organization.(2) A certified copy of the original postsecondary educational institution diploma from which the applicant graduated. The following are requirements in the event that such diploma has been lost or destroyed: (A) The applicant shall submit, in lieu thereof, a statement under the signature and seal of the dean of the postsecondary educational institution from which the applicant graduated, stating that the applicant has satisfactorily completed the prescribed course of study, the actual degree conferred, and the date of graduation.(B) The applicant shall submit an affidavit fully and clearly stating the circumstances under which his or her diploma was lost or destroyed.(C) In exceptional circumstances, the board may accept, in lieu of a diploma or certified copy thereof, other types of evidence, which establish that the applicant received a diploma and completed all academic requirements relating thereto.(3) An original transcript of the applicant's postsecondary education, including the degree conferred and the date the degree was conferred. If an original transcript is not available, the applicant must submit the following: (A) A notarized or certified copy of the original transcript, which must include the degree conferred and the date the degree was conferred.(B) An affidavit fully and clearly stating the reasons that an original transcript is not available.(4) The applicant shall submit evidence of the following to the board: (A) Satisfactory completion of an educational curriculum approved by the Midwifery Education Accreditation Council or a successor organization, or the educational equivalent of a Midwifery Education Accreditation Council curriculum approved by the board.(B) Documented practical experience as outlined in the Certified Professional Midwife credentialing process in accordance with the standards of the North American Registry of Midwives or a successor organization.(C) Certification in adult cardiopulmonary resuscitation conferred by an accredited association approved by the board.(D) Completion of the American Academy of Pediatrics program in neonatal resuscitation, excluding endotracheal intubation and the administration of drugs.(E) Completion of the Certified Professional Midwife credentialing process birth requirements, observation of an additional twenty (20) births, attendance at an additional twenty (20) births conducted by a physician, assistance with an additional twenty (20) births, and acting as the primary attendant for an additional twenty (20) births. The additional births must take place in the United States, and all births except the additional twenty (20) births conducted by a physician, must be overseen by a preceptor approved by the North American Registry of Midwives.(F) Completion of an emergency skills training course approved by the North American Registry of Midwives for inclusion in the Midwifery Bridge Certificate Program, which includes course material as required by IC 25-23.4-3-2(2).(G) Proof of maintaining a liability insurance policy that at a minimum provides coverage of one hundred thousand dollars ($100,000) per incident and three hundred thousand dollars ($300,000) yearly aggregate.(5) Where the name on any document differs from the applicant's name, a notarized or certified copy of a marriage certificate or legal proof of name change must be submitted with the application.(6) All applicants who are now, or have been, licensed to practice any health profession in another state must submit verification of license status. This information must be sent by the state that issued the license directly to the board.Medical Licensing Board of Indiana; 844 IAC 17-1-3; filed 4/20/2017, 9:26 a.m.: 20170517-IR-844150448FRAReadopted filed 5/30/2023, 1:19 p.m.: 20230628-IR-844230101RFAReadopted filed 2/27/2024, 10:19 a.m.: 20240327-IR-844230772RFA