653—17.5 (147,148E) Application requirements.
	 17.5(1) Application required. All registered acupuncturists shall apply for a license within 60 days of receiving an application by certified mail. Failure to apply for licensure in that time frame shall deem the registration invalid and the individual no longer qualified to practice acupuncture in Iowa.
	 17.5(2) Application for licensure. To apply for a license to practice acupuncture, an applicant shall:
	  a.   	 Submit the completed application form provided by the board, including required credentials and documents; and
	  b.   	 Pay a nonrefundable initial application fee of $300.
	 (1) 	 For current registrants, the fee to become licensed is prorated based on the expiration date of the individual’s registration. The board shall notify each registrant of the nonrefundable application fee when the board sends the application by certified mail.
	 (2) 	 For former registrants, the fee to become licensed is a nonrefundable application fee of $300.
	 17.5(3) Contents of the application form. Each applicant, other than current registrants, shall submit the following information on the application form provided by the board:
	  a.   	 The applicant’s name, date and place of birth, and home address, mailing address and principal business address;
	  b.   	 A photograph of the applicant suitable for positive identification;
	  c.   	 The other jurisdictions in the United States or other nations or territories in which the applicant is authorized to practice acupuncture, including license, certificate of registration or certification numbers, date of issuance, and an explanation indicating the basis upon which authorization to practice acupuncture was received;
	  d.   	 Full disclosure of the applicant’s involvement in civil litigation related to the practice of acupuncture in any jurisdiction of the United States, other nations or territories;
	  e.   	 Full disclosure of any disciplinary action taken against the applicant by, but not limited to, a regulatory authority, educational institution, or health facility in any jurisdiction of the United States, other nations or territories;
	  f.   	 The NCCAOM score report verification form submitted directly to the board by the NCCAOM;
	  g.   	 An official statement from NCCAOM that the applicant holds active status as a diplomate in NCCAOM or, after June 1, 2004, an official statement from NCCAOM that the applicant holds active status as a diplomate in acupuncture or oriental medicine;
	  h.   	 An official statement showing successful completion of a course in clean needle technique approved by the NCCAOM;
	  i.   	 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 the practice of acupuncture and provide patients with safe and healthful care;
	  j.   	 A description of the applicant’s clinical acupuncture training, work experience and, where applicable, supporting documentation;
	  k.   	 An official transcript sent directly from the institution of higher education or acupuncture school attended by the applicant and, if necessary, an English translation of the official transcript;
	  l.   	 Proof of the applicant’s proficiency in the English language, when the applicant has not passed the English version of the NCCAOM written and practical examinations; and
	  m.   	 A copy of the disclosure sheet to be used in practice, as described in 17.5(5).
	 17.5(4) Contents of the application form for current registrants. Each current registrant shall submit the following information on the application form provided by the board:
	  a.   	 The applicant’s name, home address, mailing address and principal business address;
	  b.   	 Full disclosure of the applicant’s involvement in civil litigation related to the practice of acupuncture in any jurisdiction of the United States, other nations or territories;
	  c.   	 Full disclosure of any disciplinary action taken against the applicant by, but not limited to, a regulatory authority, educational institution, or health facility in any jurisdiction of the United States, other nations or territories;
	  d.   	 An official statement from NCCAOM that the registrant holds active status as a diplomate in NCCAOM;
	  e.   	 An official statement showing successful completion of a course in clean needle technique approved by the NCCAOM;
	  f.   	 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 the practice of acupuncture and provide patients with safe and healthful care;
	  g.   	 A description of the applicant’s work experience in the past five years and, where applicable, supporting documentation; and
	  h.   	 A copy of the disclosure sheet used in practice, as described in 17.5(5).
	 17.5(5) Disclosure sheet. Pursuant to Iowa Code section 148E.6, applicants shall also provide a copy of the disclosure sheet to be given to each patient that includes the following information:
	  a.   	 The name, business address and business telephone number of the acupuncturist;
	  b.   	 A fee schedule;
	  c.   	 A listing of the acupuncturist’s education, experience, degrees, certificates, or other credentials related to acupuncture awarded by professional acupuncture organizations, the length of time required to obtain degrees or credentials, and experience;
	  d.   	 A statement indicating any license, certificate, or registration in a health care occupation which was revoked by any local, state, or national health care agency;
	  e.   	 A statement that the acupuncturist is complying with statutes and with rules adopted by the board, including a statement that only presterilized, disposable needles are used by the acupuncturist;
	  f.   	 A statement that the practice of acupuncture is regulated by the board; and
	  g.   	 A statement indicating that a license to practice acupuncture does not authorize a person to practice medicine and surgery in this state, and that the services of an acupuncturist must not be regarded as diagnosis and treatment by a person licensed to practice medicine and must not be regarded as medical opinion or advice.
	 17.5(6) Application cycle. Applications for initial licensure, except for current registrants, shall be open for 120 days from the date the application form is received in the board’s office.
	  a.   	 After the 120 days, applicants shall update credentials and submit a nonrefundable reactivation of application fee of $100 unless granted an extension in writing by the committee or the board. The period for requesting reactivation of the application is limited to one year from the date the application form is received by the board.
	  b.   	 Once the application reactivation period is expired, applicants must reapply and submit a new, nonrefundable initial application fee of $300.
	 17.5(7) Applicant responsibilities. An applicant for licensure to practice acupuncture bears full responsibility for each of the following:
	  a.   	 Paying all fees charged by regulatory authorities, national testing or credentialing organizations, health facilities, and educational institutions providing the information specified in 17.5(3);
	  b.   	 Providing accurate, up-to-date, and truthful information on the application form including, but not limited to, that specified under 17.5(3) and 17.5(4) related to prior professional experience, education, training, examination scores, diplomate status, licensure or registration, and disciplinary history; and
	  c.   	 Submitting English translations of documents in foreign languages bearing the affidavit of the translator certifying that the translation is a true and complete translation of the foreign language original. The applicant shall bear the expense of the translation.
	 17.5(8) Board responsibilities. The board staff shall review new applications within two weeks of submission of all requested materials. If the individual clearly meets all of the requirements, staff may issue the license. If staff has any concern about the application, it shall be referred to committee at its next meeting. If the committee resolves the concern, staff may issue the license. If the committee recommends denial, the application will be referred to the board.
	 17.5(9) Grounds for denial of application. The board, on the recommendation of the committee, may deny an application for licensure for any of the following reasons:
	  a.   	 Failure to meet the requirements for licensure specified in rule 653—17.4(147,148E) as authorized by Iowa Code section 148E.2 or of this chapter of the board’s rules.
	  b.   	 Pursuant to Iowa Code section 147.4, upon any of the grounds for which licensure may be revoked or suspended as specified in Iowa Code sections 147.55 and 148E.8 or in rule 653—17.12(147,148E,272C).
	 17.5(10) Waiver or variance prohibited. Provisions of this rule are not subject to waiver or variance pursuant to IAC 653—Chapter 3 or any other provision of law.