R9-11-602. Designated Database Information

A. A Board shall establish a process for requesting the information in subsection (B): 1. From an individual applying for an initial license, certification, or registration, at the time of application; and 2. From an individual regulated by the Board, in compliance with A.R.S. § 32-3249.01(A). B. A Board shall request the following information about an individual, in a Department-provided format: 1. The individual’s name; 2. The individual’s date of birth; 3. The individual’s gender; 4. The individual’s race and ethnicity; 5. If applicable, the individual’s National Provider Number; 6. Whether the individual is able to provide services to patients or clients in a language other than English and, if so, in which languages; 7. The type of license, certification, or registration held by the individual or for which the individual is applying; 8. The individual’s professional license, registration, or certification number, if applicable; 9. The beginning and end date of the individual’s current license, certification, or registration, if applicable; 10. The individual’s highest level of training or education related to the individual’s license, certification, or registration; 11. The individual’s highest level of education in another field; 12. The individual’s current employment status; 13. Whether the individual is currently providing direct patient care related to the individual’s license, certification, or registration, as applicable, on a regular basis in Arizona and, if so: a. The zip code of the individual’s primary practice location; b. The type of facility in which the individual is providing direct patient care at the primary practice location; c. The number of weeks worked over the previous 12 months at the primary practice location; d. The average hours worked per week at the primary practice location, including the percentage of time spent in: i. Direct patient care; ii. Administration, including any paperwork not part of direct patient care; iii. Research; iv. Teaching or education; or v. Other specified activities; e. Whether the individual expects a change in subsection (B)(13)(b), (c), or (d) in the next 12 months; and f. If the individual expects to reduce the time spent providing direct patient care in the next 12 months, the reason for the change; and 14. If the individual is a physician, physician assistant, or registered nurse practitioner, whether the individual provides primary care services, as defined in A.A.C. R9-24- 201.