Section R4-25-306. License Renewal

On or before June 30 of each year, a licensee shall submit the renewal fee required in R4-25-103 and:

1.        A renewal application that contains the following infor- mation:

a.        The licensee’s name, home and business mailing addresses, and location of practice;

b.        Whether the licensee has been named as a defendant in a medical malpractice matter during the 12 months before the date of the renewal application, including:

i.         The name of the court having jurisdiction over the medical malpractice matter and case num- ber assigned to the medical malpractice matter, and

ii.        Copies of all court documents relating to the medical malpractice matter;

c.        Whether the licensee has been convicted of a felony or a misdemeanor involving moral turpitude during the 12 months before the date of the renewal appli- cation;

d.        Whether the licensee’s malpractice or professional liability insurance has been denied, suspended, or revoked during the 12 months before the date of the renewal application;

e.        Whether the licensee’s Drug Enforcement Adminis- tration Certificate of Registration required in R4-25- 602 has been suspended or revoked during the 12 months before the date of the renewal application, or is currently under investigation;

f.         Whether the licensee has had a license, certification, or registration, other than a driver’s license, sus- pended or revoked by any state or jurisdiction during the 12 months before the date of the renewal appli- cation;

g.        Whether the licensee has been treated for alcoholism or drug abuse during the 12 months before the date of the renewal application;

h.        Whether the licensee has a medical condition that in any way impairs or limits the licensee’s ability to practice podiatric medicine;

i.         Whether the licensee has been denied staff member- ship in a hospital or other health care institution, as defined in A.R.S. § 36-401, during the 12 months before the date of the renewal application;

j.         Whether the  licensee has been  investigated by a health insurance company for health insurance fraud during the 12 months before the date of the renewal application; and

k.        A statement by the licensee that the information on the renewal application is true and correct and the licensee’s signature;

2.        If the licensee answers yes to any of the questions in sub- sections (1)(c) through (1)(j), an explanation of each answer including applicable dates, outcomes, and current status; and

3.        The written report required in R4-25-503 for continuing education, including a notarized affirmation of attendance signed by the licensee.

Historical Note

New Section made by final rulemaking at 9 A.A.R. 1846, effective July 19, 2003 (Supp. 03-2).