Section R4-8-203. Application for Acupuncture License

A.      To be licensed to practice acupuncture, an applicant shall sub- mit an application packet to the Board that includes:

1.        An application, on a form provided by the Board, that provides the following information about the applicant:

a.         Name;

b.        Other names by which the applicant has been known;

c.         Date of birth;

d.        Social Security number;

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

f.         Home, business, and mobile telephone numbers;

g.        A statement of whether the applicant has ever been permitted by law to practice acupuncture in another state, territory, or district of the United States, or another country or subdivision of another country, and if so:

i.         A list of the jurisdictions in which the applicant has been permitted by law to practice acupunc- ture;

ii.        The number of each license;

iii.      The date each license was issued;

iv.       The date each license expired or expires;

v.        Limitations, if any, for each license;

vi.       Current status of each license; and

vii.     Whether each license was granted by endorse- ment, examination, or another means;

h.        A statement of whether the applicant is certified by the NCCAOM, and if so, whether the certification is active and current, and the dates of issuance and expiration;

i.         A statement of whether the applicant is certified by another certifying body, and if so, the name and address of the certifying body, and the dates of issu- ance and expiration of the certification;

j.         A statement of whether the applicant has passed a certifying or licensing examination in acupuncture, and if so, the name and address of the organization administering the examination;

k.        A statement of whether the applicant has completed an  acupuncture   program  accredited   within    the

United States or another country or subdivision of another country, and if so, the date of program com- pletion;

l.         A statement of whether the applicant has ever had a licensing authority of another state, district, or terri- tory of the United States, or another country or sub- division of another country, deny the applicant a license or certificate to practice acupuncture, and if so, the name of the jurisdiction denying a license or certificate, date of the denial, and an explanation of the circumstances;

m.       A statement of whether the applicant has ever had a licensing authority of another state, district, or terri- tory of the United States, or another country or sub- division of another country, revoke, suspend, limit, restrict, or take any other action regarding the appli- cant’s license or certificate to practice acupuncture, and if so, the name of the jurisdiction taking the action, the action taken, date of the action, and an explanation of the circumstances;

n.        A statement of whether the applicant has ever been convicted of a crime, including driving under the influence of drugs or alcohol, other than a minor traffic offense, and if so, the name of the jurisdiction in which convicted, the nature of the crime, date of the conviction, and current status;

o.        A statement of whether the applicant has ever had a claim for malpractice or a lawsuit filed against the applicant alleging professional malpractice or negli- gence in the practice of acupuncture, and if so, the claim or case number, date of the claim or lawsuit, the matters alleged, and whether the claim or lawsuit is still pending or the manner in which it was resolved;

p.        A statement of whether the applicant has any condi- tion that may impair the applicant’s ability to prac- tice acupuncture safely and skillfully, and if so, the nature of the condition and any accommodations necessary;

q.        A statement of whether the applicant has ever resigned, voluntarily or involuntarily, from a health- care facility while under investigation, and if so, the name of the health-care facility, the date of the resig- nation, and an explanation of the circumstances; and

r.         A statement of whether the applicant has ever had a health-care facility terminate, restrict, or take any other action regarding the applicant’s employment, professional training, or privileges, and if so, the name of the health-care facility, the date of the action, and an explanation of the circumstances;

2.        An official record or document that relates to the appli- cant’s explanation of an item under subsections (1)(l) through (1)(r);

3.        Documentation of one of the following:

a.         Certification from the NCCAOM or its successor;

b.        Certification by another certifying body recognized by the Board;

c.         Certification as a result of passing a licensing or cer- tifying examination in acupuncture; or

d.        Authorization by law to practice acupuncture in another state, district, or territory of the United States, or another country or subdivision of another country with licensing standards substantially simi- lar to those in this Chapter that has not been revoked;

4.        Documentation of successfully completing a Board- approved clean needle technique course. A copy of the certificate of completion showing the name of the course and the date on and location at which the course was completed is acceptable documentation;

5.        A 2" X 2" photograph, taken within the last year, that shows the front of the applicant’s face and that the appli- cant signs on the back or the white frame around the pho- tograph;

6.        A completed Arizona Statement of Citizenship and Alien Status for State Public Benefits, which is a form available from the Board; and

7.        The application and initial licensing fees prescribed by the Board under R4-8-106(A)(1) and (A)(2).

B.       In addition to the materials required under subsection (A), an applicant shall provide evidence that the applicant completed at least 1,850 hours of training in acupuncture, including at least 800 clinical hours, by having submitted directly to the Board:

1.        An official transcript from each school at which the appli- cant attended a Board-approved acupuncture program showing:

a.         The name and address of the school,

b.        The  dates  on  which  the  applicant  attended   the school,

c.         The courses and clinical training completed by the applicant,

d.        The number of hours in each course or clinical train- ing,

e.         The grade or score obtained by the applicant in each course or clinical training, and

f.         Whether the applicant received a diploma or degree from the school, and

2.        An official record from any Board-approved preceptor- ship training program attended by the applicant showing:

a.         The name and address of the preceptorship training program,

b.        The name of the Board-approved supervising pre- ceptor,

c.         The dates on which the applicant attended the pre- ceptorship training program,

d.        The subject matter of all didactic and clinical train- ing,

e.         The number of hours spent on each subject,

f.         The grade or score obtained by the applicant in each subject, and

g.        Whether the applicant received a certificate of com- pletion from the preceptorship training program.

C.      In addition to complying with subsections (A) and (B), an applicant shall sign, date, and have notarized an affidavit that indicates all information provided in the application packet, including any accompanying documents submitted by or on behalf of the applicant, are true, complete, and correct.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 2534, effective June 12, 2000 (Supp. 00-2). Amended by

final rulemaking at 14 A.A.R. 690, effective April 5,

2008 (Supp. 08-1).