HAR §16-85-46
HAR §16-85-46. §16-85-46 Certification application
Length: 351 wordsOfficial source
Cite as Haw. Code R. § 16-85-46
(a) An application for certification
shall be made under oath on a form to be provided by the board. The form may
require the applicant to provide:
(1)
The appropriate fees including the application fee which shall not
be refunded;
(2)
The applicant’s full name;
(3)
Evidence of graduation from a board approved school or training
program;
(4)
Evidence of passage of the national certification examination
developed by the National Commission on Certification of
Physician’s Assistants (NCCPA);
(5)
Evidence of current NCCPA certification;
(6)
Information regarding any conviction of any crime which has not
been annulled or expunged;
(7)
A completed Federation Discipline Report from the Federation of
State Medical Boards;
(8)
If applicable, evidence of any certifications held or once held in
other jurisdictions indicating the status of the certification and
documenting any disciplinary action;
(9)
Any other information the board may require to investigate the
applicant’s qualifications for certification;
(10)
A statement signed by the licensed physician or group of
physicians, as the case may be, stating that the physician or group
of physicians will direct and supervise the physician assistant and
that the physician assistant will be considered the agent of the
physician or group of physicians; and
(11)
The name of the employer.
(b)
An application for a temporary certificate shall be made under oath
on a form to be provided by the board. The form shall require the applicant to
provide verification from the NCCPA that the applicant is scheduled to take the
next scheduled examination and items listed in subsection (a) above with the
exception of items (4) and (5). Graduation from a board approved school or
training program shall have occurred within twelve months of the date of
application.
(c)
It shall be the applicant’s responsibility to furnish any information
and documentation requested by the board.
In the event of any change of
information provided, the applicant shall notify the board of any change within
thirty days of any change.
(d)
Every application and all references shall be signed by the applicant
or the person attesting to the applicant’s education, experience, employment, and
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