N.H. Admin. Code § Acp 702.01

Current through Register No. 50, December 12, 2024

Section Acp 702.01 - Acupuncture Detoxification Specialist Application

(a) Each applicant for certification as an acupuncture detoxification specialist shall complete and submit to the board an "Acupuncture Detoxification Specialist Certification Application", effective July 2018 and available on the board's website, which includes the following on or attached to the form:

(1) The applicant's legal name, other names the applicant has been known by and reason for name change, mailing address, and telephone number(s);

(2) The date(s) the applicant attended and completed NADA or other board-approved training;

(3) The date of application;

(4) The applicant's signature;

(5) The primary practice location address that the acupuncture detoxification services will be performed;

(6) Any additional practice location addresses;

(7) The applicant's date of birth;

(8) The applicant's social security number, as required by RSA 161-B:11, VI-a;

(9) The applicant's email address;

(10) A copy of the NADA ethics pledge, or ethics pledge issued by other board-approved training programs, statement signed by the applicant;

(11) A copy of the NADA or other board-approved training certificate of training completion;

(12) Application fee of $110.00;

(13) The following information about the supervising acupuncturist:

a.Name, mailing address, and telephone number(s);

b.License number and expiration date; and

c.The supervising acupuncturist's signature attesting that he or she agrees to abide by Acp 703.01;

(14) Attestation from the supervising acupuncturist of their own familiarity with:

a.The NADA Acupuncture Detoxification Specialist Training Manual, effective July 1, 2017, available as noted in Appendix II;

b.Prior NADA training that meets or exceeds the NADA training; or

c.Other board-approved training;

(15) An indication as to whether the applicant has had an acupuncture detoxification certificate, license, or other similar registration revoked, suspended, or limited in this or any other state or jurisdiction;

(16) An indication as to whether the applicant has had a professional license or certification in a field other than acupuncture detoxification revoked, suspended, or otherwise terminated on disciplinary grounds;

(17) An indication as to whether the applicant holds a current health care, recovery coach or peer counselor professional license, certificate or other similar credential. The applicant shall provide the professional license, certificate or credential type, number, and state of issuance;

(18) An indication as to whether the applicant has prior work or volunteer experience in substance abuse or addictions treatment or behavioral health treatment; and

(19) An indication as to whether the applicant has successfully completed clean needle technique training as outlined in the NADA Acupuncture Detoxification Specialist Training Manual, effective July 1, 2017, available as noted in Appendix II, or as outlined in the training approved pursuant to Acp 705.

(b) The applicant shall provide a detailed explanation to any affirmative answer given in response to questions (15)-(19) in (a) above.

N.H. Admin. Code § Acp 702.01

Derived from Volume XXXVIII Number 32, Filed August 9, 2018, Proposed by #12575, Effective 7/20/2018, Expires 7/20/2028.