653—9.6 (147,148) Licensure by expedited endorsement.
	   9.6(1) Applicant eligibility. An applicant who has been licensed in any United States jurisdiction or Canada for more than five years shall meet the following requirements to be eligible for permanent licensure by expedited endorsement.
	   9.6(2) Requirements. To apply for permanent licensure by expedited endorsement, an applicant shall:
	      a.    	 Pay a nonrefundable initial application fee of $450 plus the $45 fee identified in 653—subrule 8.4(6) for the evaluation of the fingerprint packet and the criminal history background checks by the Iowa division of criminal investigation (DCI) and the Federal Bureau of Investigation (FBI); and
	      b.    	 Complete and submit forms provided by the board, including required credentials, documents, a completed fingerprint packet, and a sworn statement by the applicant attesting to the truth of all information provided by the applicant.
	      c.    	 Meet the eligibility requirements set forth in subrule 9.3(1).
	      d.    	 Be licensed in at least one other United States jurisdiction or Canadian province.
	      e.    	 Hold an unrestricted license in every jurisdiction in which the applicant is licensed.
	      f.    	 Have no formal disciplinary actions; no active or pending investigations; no past, pending, public or confidential restrictions or sanctions by a board of medicine, licensing authority, medical society, professional society, hospital, medical school, federal agency, or institution staff sanctions in any state, country or jurisdiction.
	      g.    	 Hold current specialty board certification by an ABMS or AOA specialty board. Lifetime certification is excluded.
	      h.    	 Have been engaged in continuous, active practice within the five years immediately preceding the date of submitting an application for licensure. Continuous, active practice includes private practice, employment in a hospital or clinical setting, employment by any governmental entity in community or public health, or practice of administrative, academic or research medicine. Continuous, active practice does not include residency, fellowship or postgraduate training of any kind.
	   9.6(3) Application. The application shall require the following information:
	      a.    	 Full legal name, date and place of birth, home address, mailing address and principal business address.
	      b.    	 A photograph of the applicant suitable for positive identification.
	      c.    	 A statement listing every jurisdiction in which the applicant is or has been authorized to practice, including license numbers and dates of issuance.
	      d.    	 A chronology accounting for all time periods from the date the applicant entered medical school to the date of the application.
	      e.    	 Verification of an applicant’s hospital and clinical staff privileges and other professional experience for the past five years if requested by the board.
	      f.    	 A statement disclosing and explaining any informal or nonpublic actions, warnings issued, investigations conducted, or disciplinary actions taken, whether by voluntary agreement or formal action, by a medical or professional regulatory authority, an educational institution, a training or research program, or a health facility in any jurisdiction.
	      g.    	 A statement of the applicant’s physical and mental health, including full disclosure and a written explanation of any dysfunction or impairment which may affect the ability of the applicant to engage in practice and provide patients with safe and healthful care.
	      h.    	 A statement disclosing and explaining the applicant’s involvement in civil litigation related to practice in any jurisdiction. Copies of the legal documents may be requested if needed during the review process.
	      i.    	 A statement disclosing and explaining any charge of a misdemeanor or felony involving the applicant filed in any jurisdiction, whether or not any appeal or other proceeding to have the conviction or plea set aside is pending.
	      j.    	 A completed fingerprint packet to facilitate a national criminal history background check. The fee for the evaluation of the fingerprint packet and the DCI and FBI criminal history background checks will be assessed to the applicant.
Note: The board reserves the right to request information listed in rule 653—9.5(147,148).
[ARC 8554B, IAB 3/10/10, effective 4/14/10; ARC 0215C, IAB 7/25/12, effective 8/29/12; ARC 1187C, IAB 11/27/13, effective 1/1/14]