W. Va. Code R. § 24-1-12

Current through Register Vol. XLI, No. 43, October 25, 2024

Section 24-1-12 - Application Forms and Processing

12.1. Application forms for licensure may include, but not be limited to, requirements for the following information as considered necessary by the Board:

12.1.1. An AOA bibliographical printout;

12.1.2. A Federation of State Medical Boards derogatory information sheet regarding other state board actions;

12.1.3. A list of all states where the applicant has had a license, even if the license is not active;

12.1.4. A list of all hospitals where the physician has had privileges in the last 5 years;

12.1.5. The applicant's medical school;

12.1.6. A list of all training programs, including post-graduate training programs;

12.1.7. A copy of a marriage license, divorce decree or court order, to document a name change;

12.1.8. The place and date of the applicant's birth; and

12.1.9. A malpractice liability claims form listing all pending or finalized malpractice liability claims against the applicant.

12.2. In the event the Board's staff finds derogatory information during the processing of an application, the information shall be presented to the Board for its review and the determination as to whether an individual should be scheduled for an interview during a regular Board meeting or if the staff should obtain additional information.

12.3. It is the applicant's responsibility to submit all necessary forms to selective institutions for response to the Board, except where FCVS is providing the information directly to the Board.

12.4. Completed original verification forms shall be mailed directly from institutions, except where FCVS is providing the information directly to the Board.

12.5. The Board reserves the right to obtain additional information through oral or written examinations, psychiatric evaluation, physical examination or other tests as may be necessary to determine the competency of the applicant. Any additional tests, exams etc., are the financial responsibility of the applicant.

12.6. The Board reserves the right to require an applicant to take a written exam or practical skills assessment examination as appropriate, for the practice of osteopathic medicine.

12.7. Evidence and information described in this section may be provided through FCVS, where available through FCVS.

W. Va. Code R. § 24-1-12