Section 12.16.031. Application for temporary permit for locum tenens practice.

	(a)  A person applying for a temporary permit for locum tenens practice must meet the applicable requirements of AS 08.20.163 and this section, including passing the state chiropractic examination described in 12 AAC 16.130.  
	(b)  An applicant applying for a temporary permit for locum tenens practice under AS 08.20.163(b)(1) and this section shall submit  
		(1) a completed application on a form provided by the department;  
		(2) the applicable fees established in 12 AAC 02.150;  
		(3) official college transcripts showing that the applicant meets the education requirements of AS 08.20.120(a)(2) - (4); and  
		(4) an official grade transcript sent directly to the department from the National Board of Chiropractic Examiners showing that the applicant has successfully passed the applicable national examinations described in 12 AAC 16.037.  
	(c)  An applicant applying for a temporary permit for locum tenens practice under AS 08.20.163(b)(2) and this section shall submit  
		(1) a completed application on a form provided by the department;  
		(2) the applicable fees established in 12 AAC 02.150;  
		(3) an official college transcripts showing that the applicant meets the education requirements of AS 08.20.l63(b)(2)(C) and (D);  
		(4) an official grade transcript sent directly to the department from the National Board of Chiropractic Examiners showing that the applicant has successfully passed the examinations described in AS 08.20.l63(b)(2)(D) and (E);  
		(5) verification of practice showing that the applicant meets the requirements of AS 08.20.163(b)(2)(B);  
		(6) verification of the applicant's licensure status and complete information regarding any disciplinary action or investigation taken or pending, sent directly to the department from all licensing jurisdictions where the applicant holds or has ever held a chiropractic license; and  
		(7) a notarized, sworn statement by the applicant that the applicant has not been, within the five years preceding the date of application, the subject of an unresolved review or an adverse decision based upon a complaint, investigation, review procedure, or disciplinary proceeding undertaken by a state, territorial, local, or federal chiropractic licensing jurisdiction, chiropractic society, or law enforcement agency that relates to criminal or fraudulent activity, chiropractic malpractice, or negligent chiropractic care and that adversely reflects on ability or competence to engage in the practice of chiropractic or the safety or well-being of patients;  
		(8) repealed 5/27/2006.  
	(d)  An applicant applying for a temporary permit for locum tenens practice under AS 08.20.163 and this section shall submit  
		(1) a notarized, sworn statement by the chiropractor licensed in this state for whom the applicant will substitute, including the dates of the substitute practice and the date that the chiropractor licensed in this state will resume practice; and  
		(2) a report under AS 12.62  containing criminal history record information concerning the applicant and issued no earlier than 90 days before the application; if a state other than this state is the applicant's primary state of residence, or if the applicant holds or has ever held a license in a state other than this state to practice chiropractic, the applicant shall also submit an equivalent report issued by that other state and issued no earlier than 90 days before the application.  

Authorities

08.20.055;08.20.120;08.20.163;08.20.170

Notes

Reference

12 AAC 16.170

Authority

AS 08.20.055 AS 08.20.120 AS 08.20.163 AS 08.20.170

History

Eff. 1/6/2002, Register 161; am 5/27/2006, Register 178; am 1/29/2009, Register 189; am 8/14/2010, Register 195