Section R4-24-208. License or Certificate Renewal; Address Change

A.      A licensee or certificate holder shall submit a renewal applica- tion packet to the Board on or before August 31 of an even- numbered year that includes:

1.        The following information for the license or certificate period immediately preceding the renewal application:

a.         The licensee’s or certificate holder’s:

i.         Name;

ii.        Home, business, and e-mail addresses; and

iii.      Home and business telephone numbers;

b.        A statement of whether the licensee or certificate holder has been convicted of, pled guilty or no con- test to, or entered into diversion in lieu of prosecu- tion for any criminal offense in any jurisdiction of the United States or foreign country and if so, an explanation;

c.         A statement of whether the licensee or certificate holder has had an application for a professional or occupational license, certificate, or registration, other than a driver’s license, denied, rejected, sus- pended, or revoked by any jurisdiction of the United States or foreign country and if so, an explanation;

d.        A statement of whether the licensee or certificate holder is currently or ever has been under investiga- tion, suspension, or restriction by a professional licensing board in any jurisdiction of the United States or foreign country for any act that occurred in that jurisdiction that would be the subject of disci- pline under this Chapter and if so, an explanation;

e.         A statement of whether the licensee or certificate holder has been the subject of disciplinary action by a professional association or postsecondary educa- tional institution;

f.         A statement of whether the licensee or certificate holder has had a malpractice judgment against the licensee or certificate holder or has a lawsuit cur- rently pending for malpractice and if so, an explana- tion;

g.        A statement of whether the licensee or certificate holder is currently more than 30 days in arrears for payment required by a judgment and order for child support in Arizona or any other jurisdiction;

h.        A statement of whether the licensee or certificate holder has adhered to the recognized standards of ethics;

i.         A statement of whether the licensee or certificate holder has or has not committed any of the actions referenced in the definition of good moral character in R4-24-101;

j.         A statement of whether the licensee or certificate holder has been the subject of any criminal investi- gation by a federal, state, or local agency or had criminal charges filed against the licensee or certifi- cate holder;

k.        If a licensee, a statement of whether the licensee has:

i.         Any impairment to the licensee’s cognitive, communicative, or physical ability to engage in the practice of physical therapy with skill and safety and if so, an explanation;

ii.        Used alcohol, any illegal chemical substance, or prescription medicine, that in any way has impaired or limited the licensee’s ability to practice physical therapy with skill and safety and if so, an explanation;

iii.      Been diagnosed as having or is being treated for bipolar disorder, schizophrenia, paranoia, or other psychotic disorder that in any way has impaired or limited the licensee’s ability to practice physical therapy with skill and safety and if so, an explanation;

l.         If a certificate holder, a statement of whether the cer- tificate holder has:

i.         Any impairment to the certificate holder’s cog- nitive, communicative, or physical ability to work as a physical therapist assistant with skill and safety and if so, an explanation;

ii.        Used alcohol, any illegal chemical substance or prescription medicine, that in any way has impaired or limited the certificate holder’s abil- ity to work as a physical therapist assistant with skill and safety and if so, an explanation;

iii.      Been diagnosed as having or is being treated for bipolar disorder, schizophrenia, paranoia, or other psychotic disorder that in any way has impaired or limited certificate holder’s ability to work as a physical therapist assistant with skill and safety and if so, an explanation;

m.       A statement of whether the licensee or certificate holder has ever violated A.R.S. § 32-2044(10);

n.        If a licensee, a statement of whether the licensee has completed the 20 contact hours of continuing com- petence for the previous compliance period as required in R4-24-401(A) and (E); and

o.        If a licensee, a statement of whether the licensee has complied with the medical records protocol as required in A.R.S. § 32-3211.

p.        If a licensee, a statement of whether the licensee has completed the dry needling course content require- ments in A.A.C. R4-24-313.

2.        The signature of the applicant attesting to the truthfulness of the information provided by the licensee or certificate holder;

3.        Evidence of the applicant’s U.S. citizenship, alien status, legal residency, or lawful presence in the U.S.; and

4.        The fee required by the Board in R4-24-107.

B.       Failure of the Board to inform a licensee or certificate holder of license or certificate expiration does not excuse the licensee’s or certificate holder’s non-renewal or untimely renewal.

C.      The Board shall:

1.        Approve or deny the application within the time-frames in R4-24-209 and Table 1, and

2.        Deny the application of an applicant who does not meet the requirements in A.R.S. § 32-2001 et seq. or this Chap- ter.

D.      A licensee or certificate holder denied renewal of a license or certificate may request a hearing under A.R.S. Title 41, Chap- ter 6, Article 10.

E.       A licensee or certificate holder shall send to the Board written notification of a change in any of the information provided under subsection (A)(1)(a) no later than 30 days after the date of the change.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 2399, effective June 9, 2000 (Supp. 00-2). Amended by

final rulemaking at 12 A.A.R. 2401, effective August 5,

2006 (Supp. 06-2). Amended by final rulemaking at 14

A.A.R. 376, effective March 8, 2008 (Supp. 08-1). Amended by final rulemaking at 14 A.A.R. 3418, effec- tive October 4, 2008, (Supp. 08-3). Amended by final rulemaking at 18 A.A.R. 1858, effective July 10, 2012 (Supp. 12-3). Amended by final exempt rulemaking at 21

A.A.R. 924, effective July 1, 2015 (Supp. 15-2).