Section R4-16-203. Application for Locum Tenens Registration

A.      An applicant for a locum tenens registration to practice medi- cine for a maximum of 180 consecutive days in Arizona shall

submit an application form available on request from the Board and on the Board’s web site that provides the informa- tion required under R4-16-201(B).

B.       In addition to the application form required under subsection (A), an applicant for a locum tenens registration to practice medicine shall have the following submitted directly to the Board, electronically or in hard copy, by the primary source, ECFMG, Veridoc, or FCVS:

1.        Official transcript or other authentication of graduation from a school of medicine;

2.        Verification of completion of postgraduate training;

3.        A statement completed by the sponsoring Arizona- licensed physician giving the reason for the request for issuance of the registration;

4.        Verification of ECFMG certification if the applicant grad- uated from an unapproved school of medicine; and

5.        Verification of licensure from every state in which the applicant has ever held a medical license.

C.      In addition to the application form required under subsection (A), an applicant for a locum tenens registration to practice medicine shall submit the following:

1.        Documentation listed under A.R.S. § 41-1080(A) show- ing that the applicant’s presence in the U.S. is authorized under federal law;

2.        A full set of fingerprints and the charge specified in R4- 16-205;

3.        A copy of a government-issued photo identification; and

4.        The fee specified under R4-16-205.

Historical Note

Adopted effective September 22, 1995 (Supp. 95-3). Amended by final rulemaking at 8 A.A.R. 2319, effective May 9, 2002 (Supp. 02-2). Former Section R4-16-203 recodified to R4-16-303; New Section R4-16-203 recodi- fied from R4-16-108 at 11 A.A.R. 1283, effective March 25, 2005 (Supp. 05-1). Amended by final exempt

rulemaking at 21 A.A.R. 2678, effective October 15,

2015 (Supp. 15-4).