R4-16-203. Application for Locum Tenens Registration

A. An applicant for a locum tenens registration to practice medicine 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 information 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 Arizonalicensed physician giving the reason for the request for issuance of the registration; 4. Verification of ECFMG certification if the applicant graduated 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) showing 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.