N.H. Admin. Code § Plc 1505.03

Current through Register No. 50, December 12, 2024

Section Plc 1505.03 - Supervision Form

(a) The supervision form required by Plc 1504.05(b) shall be the "Supervision of Respiratory Care Conditional Licensee" form dated January 2023, as further described in (e), below.

(b) The individual to be supervised shall:

(1) Legibly complete part I of the form, entitled "To be completed by the Applicant/Conditional Licensee (individual to be supervised)"; and

(2) Give the form to the individual who will provide supervision.

(c) The individual who intends to provide supervision shall:

(1) Legibly complete part II of the form, entitled "To be completed by the Supervisor";

(2) Sign and date the form; and

(3) Return the form to the licensing bureau.

(d) The signature required on the form by (c), above, shall constitute the supervisor's attestation that the supervisor:

(1) Is licensed to practice respiratory care in New Hampshire without limitation or restriction;

(2) Has read and understands Plc 1505 governing the supervision;

(3) Agrees to undertake the duties of supervision;

(4) Agrees to take responsibility for the acts and omissions of any individual to whom the signer delegates the duties of supervision under Plc 1505.04; and

(5) Understands that the failure of the signer or the signer's delegate to follow the rules governing the supervision has the potential to subject the signer to disciplinary sanctions.

(e) The "Supervision of Respiratory Care Conditional Licensee" form dated January 2023 shall comprise 2 parts, as follows:

(1) Part I, entitled "To be completed by the Applicant/Conditional Licensee (individual to be supervised)", shall require the applicant or conditional licensee to provide the following information:

a. The individual's full legal name;

b. The date the application is being submitted; and

c. If the individual's place of employment is known, the name, address, and telephone number of the place of employment; and

(2) Part II, entitled "To be completed by the Supervisor", shall require the supervisor to provide the following information:

a. The supervisor's full legal name and New Hampshire license number;

b. The name, address, and telephone number of the supervisor's employer;

c. The name, location, and telephone number of the site where the supervision will occur; and

d. The date the supervision is anticipated to start and the date the supervision is anticipated to end.

(f) If the identified supervisor becomes unable to serve as the supervisor for any reason that is not temporary as provided in Plc 1505.04, the conditional licensee shall complete the steps in (b) through (d), above, with a new supervisor.

N.H. Admin. Code § Plc 1505.03

Derived from Volume XLII Number 49, Filed December 8, 2022, (See Revision Note at chapter heading for Plc 1500), Proposed by #13496, Effective 11/27/2022, Expires 5/23/2023.

Amended by Number 19, Filed May 11, 2023, Proposed by #13621, Effective 5/22/2023, Expires 5/22/2033 (see Revision Note #2 at chapter heading for Plc 1500).