Section 12.40.015. Application for license by examination.

	(a)  Repealed 6/28/97.  
	(b)  A complete application for a license by examination must meet the requirements of AS 08.64.200, 08.64.205, 08.64.209, or 08.64.225 and include the following documents  
		(1) submitted by the applicant:  
			(A) a completed application on a form provided by the department, including a photograph of the applicant and the applicant's notarized signature;  
			(B) a completed authorization for release of records on a form provided by the department and signed by the applicant;  
			(C) repealed 4/2/2004;  
			(D) a statement listing each hospital at which the applicant has held privileges within the five years immediately before the date the applicant signs the application form;  
			(E) all required application and licensing fees;  
			(F) a certified true copy of the applicant's medical, osteopathy, or podiatry school diploma or certificate;  
			(G) if applicable, a certified true copy of each of the applicant's post-graduate training program certificates;  
		(2) requested by the applicant from appropriate agencies and sent directly to the division office:  
			(A) original letters of verification of hospital privileges from each of the hospitals listed by the applicant in (1)(D) of this subsection; the letters of verification must include  
				(i) confirmation of the date of privileges held by the applicant;  
				(ii) information on any disciplinary action taken against the applicant;  
				(iii) any derogatory information on record about the applicant; and  
				(iv) any reason for which the applicant would not be readmitted to privileges in that facility;  
			(B) clearance from the federal Drug Enforcement Administration (DEA);  
			(C) clearance from the Federation of State Medical Boards or the Federation of Podiatric State Medical Boards;  
			(D) a Physician Profile from the American Medical Association (AMA) or the American Osteopathic Association (AOA), if applicable;  
			(E) for foreign medical graduates, a certified true copy of the applicant's certificate from the Educational Commission for Foreign Medical Graduates (ECFMG);  
			(F) verification from the applicant's medical school that the applicant completed medical school or received a medical school diploma;  
			(G) if applicable, verification of completion of the first year of post-graduate training from the facility where the applicant completed the first year of internship or residency program.  
	(c)  After passing the written examination an applicant must be interviewed in accordance with AS 08.64.255 if the board determines that, under 12 AAC 40.055, an interview is required before the board will consider issuance of a license.  
	(d)  Before the board will consider issuance of a license, an applicant  
		(1) shall provide for official examination results to be sent to the department directly from the examination agency; and  
		(2) must receive clearance from the National Practitioner Data Bank.  
	(e)  If necessary, the board will require an applicant to provide additional information to verify that the applicant meets the licensing requirements in  
		(1) AS 08.64.200, 08.64.205, 08.64.209, or 08.64.225; and  
		(2) this chapter.  
	(f)  Except for a diploma written in Latin a document submitted under this section must be either written in English or accompanied by a certified English translation of that document.  
	(g)  Notwithstanding (b)(2) of this section, an applicant for licensure by examination may submit the credentials verification documents through the Federation Credentials Verification Service of the Federation of State Medical Boards of the United States, Inc., sent directly to the department from FCVS.  

Authorities

08.64.100;08.64.180;08.64.190;08.64.205;08.64.209;08.64.210;08.64.225;08.64.240;08.64.255

Notes

Reference

12 AAC 40.016
12 AAC 40.035

Authority

AS 08.64.100 AS 08.64.180 AS 08.64.190 AS 08.64.205 AS 08.64.209 AS 08.64.210 AS 08.64.225 AS 08.64.240 AS 08.64.255 Editor's note: Copies of Medical Schools Recognized by the Medical Board of California, adopted by reference in 12 AAC 40.016, may be obtained from the Department of Commerce, Community, and Economic Development, Division of Corporations, Business, and Professional Licensing, State Medical Board, 550 W. 7th Avenue, Suite 1500, Anchorage, Alaska 99501-3567; telephone: [phone]. Information on the verification process described in 12 AAC 40.015(g) may be obtained from the Federation of State Medical Boards of the United States, Inc., P.O. Box 619850, Dallas, TX 75261-9850; telephone: [phone]; website at www.fsmb.org.

History

Eff. 7/29/83, Register 87; am 3/30/84, Register 89; am 4/10/88, Register 106; am 6/28/97, Register 142; am 8/17/97, Register 143; am 6/15/2001, Register 158; am 4/2/2004, Register 169; am 3/4/2007, Register 181; am 12/21/2007, Register 184

References

12.40.016;12.40.015