Section R4-18-501. Certificate to Engage in Clinical or Preceptorship Training

A.      To obtain a certificate to engage in clinical or preceptorship training, an applicant shall submit to the Board a complete application form provided by the Board, that allows the Board to determine if the applicant meets the requirements of A.R.S.

§ 32-1524. The application shall be verified, and include the fee listed in R4-18-107;

B.       In addition to the requirements in subsection (A) a naturo- pathic medical student who applies for a certificate to engage in  clinical  training  shall  comply  with  the  requirements   of

A.R.S. § 32-1560, and, be attending an approved naturopathic medical school. Applicant must arrange to have submitted directly to the Board, a letter from the chief medical officer of the medical school verifying that the applicant will be entering clinical training, and the anticipated starting and completion dates. The Board may deny an application for any reason set forth in A.R.S. § 32-1501(31) and A.R.S. § 32-1522(A)(3) through (6);

C.      Applicant must take and pass the examination in Arizona natu- ropathic jurisprudence that is administered by the Board, with a minimum score of 75%, include with the application a pass- port size photograph taken within 60 days prior to application submission that is signed on the back by the applicant, provide a legible fingerprint card, including the DPS processing fee as specified on the application form;

D.      The application form for clinical training entry shall include:

1.        Applicant’s full name and any former names used by applicant;

2.        Applicant’s place and date of birth;

3.        Applicant’s Social Security number;

4.        Applicant’s home and email address;

5.        Applicant’s home and cell phone numbers;

6.        The name and address of the approved naturopathic col- lege applicant is attending; name and address of clinical training program, the date of clinical entry and the date of completion of clinical entry;

7.        The name of the Supervising Physician and the name of the Chief Medical Officer of the Clinical Training pro- gram;

8.        Whether applicant has ever been arrested, charged with, convicted of, or entered into a plea of no contest to a fel- ony or a misdemeanor;

9.        Whether applicant has ever had a naturopathic medical license or certification, or any other health profession license or certification denied, suspended, rejected or revoked by any agency in any state, district or territory of the United States or another country;

10.     Whether applicant has ever been disciplined by any agency in any state, district or territory of the United States or another country, for any act of unprofessional conduct as defined in A.R.S. § 32-1501;

11.     Whether applicant, in lieu of disciplinary action, has entered into a consent agreement or stipulation with a licensing agency in any state, district or territory of the United States or another country;

12.     Whether applicant currently has an open complaint or is involved in any open investigation in any agency or court of law, in any state, district or territory of the United States or another country;

13.     Whether applicant has ever had the authority to prescribe, dispense, or administer a natural substance, drug, or device limited, restricted, modified, denied, surrendered or revoked by a federal or state agency or court of law, in any state, district or  territory of  the  United States or another country;

14.     Whether applicant has ever been found medically incom- petent;

15.     Whether applicant has ever been a defendant in any mal- practice matter that resulted in a settlement or judgment;

16.     Whether applicant has a medical condition, that in any way, impairs or limits applicant's ability to practice medi- cine;

17.     A detailed explanation and supporting documentation for each affirmative answer to questions regarding the appli- cant's background, and;

18.     A completed Arizona Statement of Citizenship and Alien Status for State Public Benefits, and copy of evidence;

E.       In addition to the requirements in subsection (A), an applicant for a certificate to engage in a preceptorship training program shall comply with the requirements of A.R.S. § 32-1561 and arrange to have submitted directly to the Board, an official transcript from the approved naturopathic medical school from which the applicant graduated;

F.       Applicant must take and pass the examination in Arizona natu- ropathic jurisprudence that is administered by the Board with a minimum score of 75%, include with the application, a pass- port size photograph taken within 60 days prior to application submission that is signed on the back by the applicant, provide a legible fingerprint card, including the DPS processing fee as specified on the application form;

G.      The application form for preceptorship training shall include:

1.        Applicant's full name and any former names used by applicant;

2.        Applicant’s place and date of birth;

3.        Applicant’s Social Security number;

4.        Applicant’s home and email address

5.        Applicant’s home and cell phone numbers;

6.        The name, address, and medical license number of the Supervising Physician, designated Supervising Physician, if any, and Chief Medical Officer;

7.        Attestation signed by the Supervising Physician declaring they have read and understand A.R.S. § 32-1561 and R4- 18-108, and agree to be the Supervising physician of record;

8.        Whether applicant has ever been arrested, charged with, convicted of, or entered into a plea of no contest to a fel- ony or a misdemeanor;

9.        Whether applicant has ever had a naturopathic medical license or certification, or any other health profession license or certification denied, suspended, rejected or revoked by any state, district or territory or the United States or another country;

10.     Whether applicant has ever been disciplined by any agency in any state, district or territory of the United States or another country, for any act of unprofessional conduct as defined in A.R.S. § 32-1501;

11.     Whether applicant, in lieu of disciplinary action by any agency, in any state, district or territory of the United States or another country, has entered into a consent agreement or stipulation with a licensing agency;

12.     Whether applicant currently has an open complaint or is involved in any open investigation in any agency or court of law, in any state, district or territory of the United States or another country;

13.     Whether applicant has ever had the authority to prescribe, dispense, or administer a natural substance, drug, or device limited, restricted, modified, denied, surrendered or revoked by a federal or state agency or court of law, in any state, district or territory of the United States, or another country;

14.     Whether applicant has ever been found medically incom- petent;

15.     Whether applicant has ever been a defendant in any mal- practice matter that resulted in a settlement or judgment;

16.     Whether applicant has a medical condition, that in any way, impairs or limits applicant's ability to practice medi- cine;

17.     A detailed explanation and supporting documentation for each affirmative answer to questions regarding the appli- cant's background; and

18.     A completed Arizona Statement of Citizenship and Alien Status for State Public Benefits, and copy of evidence.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3702, effective August 9, 2002 (Supp. 02-3). Amended by final

rulemaking at 21 A.A.R. 2009, effective September 1,

2015 (Supp. 15-3).