A.R.S. tit. 32 ch. 17 — Arizona Revised Statutes Title 32 Chapter 17 — Osteopathic Physicians And Surgeons

32-1800. Definitions In this chapter, unless the context otherwise requires: 1. "Active license" means a valid license to practice medicine and includes the license of a licensee who has been placed on probation or on whose license the board has placed restrictions. 2. "Address of record" means either: (a) The address where a person who is regulated pursuant to this chapter practices medicine or is otherwise employed. (b) The residential address of a person who is regulated pursuant to this chapter if that person has made a written request to the board that the board use that address as the address of record. 3. "Adequate records" means legible medical records containing, at a minimum, sufficient information to identify the patient, support the diagnosis, justify the treatment, accurately document the results, indicate advice and cautionary warnings provided to the patient and provide sufficient information for another licensed health care practitioner to assume continuity of the patient's care at any point in the course of treatment. 4. "Administrative warning" means a disciplinary action by the board in the form of a written warning to a physician of a violation of this chapter involving patient care that the board determines falls below the community standard. 5. "Approved postgraduate training program" means that an applicant for licensure successfully completed training when the hospital or other facility in which the training occurred was approved for a postgraduate internship, residency or fellowship by the American osteopathic association or by the accreditation council for graduate medical education. 6. "Approved school of osteopathic medicine" means a school or college offering a course of study that, on successful completion, results in the awarding of the degree of doctor of osteopathy and whose course of study has been approved or accredited by the American osteopathic association. 7. "Board" means the Arizona board of osteopathic examiners in medicine and surgery. 8. "Decree of censure" means a formal written reprimand by the board of a physician for a violation of this chapter that constitutes a disciplinary action against a physician's license. 9. "Direct supervision" means that a physician is within the same room or office suite as the unlicensed person in order to be available for consultation regarding those tasks the unlicensed person performs pursuant to section 32-1859. 10. "Dispense" means the delivery by a physician of a prescription drug or device to a patient, except for samples packaged for individual use by licensed manufacturers or repackagers of drugs, and includes the prescribing, administering, packaging, labeling and security necessary to prepare and safeguard the drug or device for delivery. 11. "Doctor of osteopathy" means a person who holds a license, registration or permit to practice medicine pursuant to this chapter. 12. "Immediate family" means the spouse, natural or adopted children, father, mother, brothers and sisters of the physician and the natural and adopted children, father, mother, brothers and sisters of the physician's spouse. 13. "Inappropriate fee" means a fee that is not supported by documentation of time, complexity or extreme skill required to perform the service. 14. "Investigative hearing" means a meeting between the board and a physician to discuss issues set forth in the investigative hearing notice and during which the board may hear statements from board staff, the complainant, the physician and witnesses, if any. 15. "Letter of concern" means an advisory letter to notify a physician that while there is insufficient evidence to support disciplinary action against the physician's license there is sufficient evidence for the board to notify the physician of its concern. 16. "Limited license" means a license that restricts the scope and setting of a licensee's practice. 17. "Medical assistant" means an unlicensed person who has completed an educational program approved by the board, who assists in a medical practice under the supervision of a doctor of osteopathic medicine and who performs delegated procedures commensurate with the assistant's education and training but who does not diagnose, interpret, design or modify established treatment programs or violate any statute. 18. "Medicine" means osteopathic medicine as practiced by a person who receives a degree of doctor of osteopathy. 19. "Physician" means a doctor of osteopathy who holds a license, a permit or a locum tenens registration to practice osteopathic medicine pursuant to this chapter. 20. "Practice of medicine" or "practice of osteopathic medicine" means all of the following: (a) To examine, diagnose, treat, prescribe for, palliate, prevent or correct human diseases, injuries, ailments, infirmities and deformities, physical or mental conditions, real or imaginary, by the use of drugs, surgery, manipulation, electricity or any physical, mechanical or other means as provided by this chapter. (b) Suggesting, recommending, prescribing or administering any form of treatment, operation or healing for the intended palliation, relief or cure of any physical or mental disease, ailment, injury, condition or defect. (c) The practice of osteopathic medicine alone or the practice of osteopathic surgery or osteopathic manipulative therapy, or any combination of either practice. 21. "Specialist" means a physician who has successfully completed postdoctoral training in an approved postgraduate training program, an approved preceptorship or an approved residency or who is board certified by a specialty board approved by the board. 22. "Subscription provider of health care" means an entity that, through contractual agreement, is responsible for the payment, in whole or in part, of debts incurred by a person for medical or other health care services. 32-1801. Arizona board of osteopathic examiners in medicine and surgery A. The Arizona board of osteopathic examiners in medicine and surgery is established consisting of seven members appointed by the governor. One member of the board shall be appointed each year for a term of five years, to begin and end on April 15. B. Before appointment by the governor, a prospective member of the board shall submit a full set of fingerprints to the governor for the purpose of obtaining a state and federal criminal records check pursuant to section 41-1750 and Public Law 92-544. The department of public safety may exchange this fingerprint data with the federal bureau of investigation. C. Two members of the board shall be public members who shall not be in any manner connected with, or have an interest in, any school of medicine or any person practicing any form of healing or treatment of bodily or mental ailments and who has demonstrated an interest in the health problems of the state. The other five members of the board shall have engaged in the practice of medicine as an osteopathic physician in this state for at least five years preceding their appointments, hold active licenses in good standing and, at the time of appointment, be practicing medicine with direct patient contact. In making appointments of each professional member of the board, the governor shall consider a list of qualified persons submitted by the Arizona osteopathic medical association and recommendations by any other person. Members of the board shall continue in office until their successors are appointed and qualified. Each board member, before entering on his duties, shall take an oath prescribed by law and in addition thereto shall make an oath as to his qualifications as prescribed in this section. No board member may serve more than two consecutive five year terms. D. The governor may remove board members if they fail to attend three or more board meetings within twelve months. This does not include telephonic meetings of the board. The governor may also remove board members for malfeasance, misfeasance or incompetence in their office, unprofessional or dishonorable conduct in their office or unprofessional or dishonorable conduct. The governor shall appoint a qualified replacement to fill a vacant position for the unexpired portion of the term. 32-1802. Meetings; organization; compensation; committees A. The board shall hold an annual meeting during the month of January each year in the Phoenix metropolitan area and may hold other meetings at times and places determined by a majority of the board on notice to each member and the general public pursuant to title 38, chapter 3, article 3.1. A majority of the members of the board constitutes a quorum, and a majority vote of a quorum present at any meeting governs all board actions. B. At each annual meeting the board shall select from among its membership a president and vice-president who shall serve until their successors are chosen. If either of these offices becomes vacant before the annual meeting, the board may elect a replacement at any other board meeting. C. Members of the board are eligible to receive compensation in the amount of two hundred fifty dollars for each day of actual service in the business of the board and reimbursement of all expenses necessarily and properly incurred in attending meetings of the board. D. Board members, the executive director, permanent or temporary board personnel, board consultants, committee members and professional medical investigators are immune from civil liability for any act they do in good faith to implement this chapter. E. To carry out the functions of the board, the board president may establish committees and define committee duties. The president shall name at least one board member to each committee the president establishes. 32-1803. Powers and duties A. The board shall: 1. Protect the public from unlawful, incompetent, unqualified, impaired and unprofessional practitioners of osteopathic medicine. 2. Issue licenses, conduct hearings, place physicians on probation, revoke or suspend licenses, enter into stipulated orders, issue letters of concern or decrees of censure and administer and enforce this chapter. 3. Maintain a record of its acts and proceedings, including the issuance, denial, renewal, suspension or revocation of licenses to practice according to this chapter. The board shall delete records of complaints only as follows: (a) If the board dismisses a complaint, the board shall delete the public record of the complaint five years after the board dismissed the complaint. (b) If the board has issued a letter of concern but has taken no further action on the complaint, the board shall delete the public record of the complaint five years after the board issued the letter of concern. (c) If the board has required additional continuing medical education pursuant to section 32-1855 but has not taken further action, the board shall delete the public record of the complaint five years after the person satisfies this requirement. 4. Maintain a public directory of all physicians and surgeons who are or were licensed pursuant to this chapter that includes: (a) The name of the physician. (b) The physician's current or last known address of record. (c) The date and number of the license issued to the physician pursuant to this chapter. (d) The date the license is scheduled to expire if not renewed or the date the license expired or was revoked, suspended or canceled. (e) Any disciplinary actions taken against the physician by the board. (f) Letters of concern, remedial continuing medical education ordered and dismissals of complaints against the physician until deleted from the public record pursuant to paragraph 3 of this subsection. 5. Adopt rules regarding the regulation, qualifications and training of medical assistants. The training requirements for a medical assistant may be satisfied through a training program that meets all of the following: (a) Is designed and offered by a physician. (b) Meets or exceeds any of the approved training program requirements specified in rule. (c) Verifies the entry-level competencies of a medical assistant as prescribed by rule. (d) Provides written verification to the individual of successful completion of the program. 6. Discipline and rehabilitate osteopathic physicians. 7. Determine whether a prospective or current Arizona licensed physician has the training or experience to demonstrate the physician's ability to treat and manage opiate-dependent patients as a qualifying physician pursuant to 21 United States Code section 823(g)(2)(G)(ii). 8. Issue registrations to administer general anesthesia and sedation in dental offices and dental clinics pursuant to section 32-1272 to physicians who have completed residency training in anesthesiology. B. The public records of the board are open to inspection at all times during office hours. C. The board may: 1. Adopt rules necessary or proper to administer this chapter. 2. Appoint one of its members to the jurisdiction arbitration panel pursuant to section 32-2907, subsection B. 3. Accept and spend federal monies and private grants, gifts, contributions and devises. These monies do not revert to the state general fund at the end of a fiscal year. 4. Develop and publish advisory opinions and standards governing the profession. D. The board shall adopt and use a seal, the imprint of which, together with the signature of either the president, vice president or executive director, is evidence of its official acts. E. In conducting investigations pursuant to this chapter, the board may receive and review confidential internal staff reports relating to complaints and malpractice claims. F. The board may make available to academic and research organizations public records regarding statistical information on doctors of osteopathic medicine and applicants for licensure. 32-1804. Executive director; compensation; duties A. Subject to title 41, chapter 4, article 4, the board shall appoint an executive director who is not a member of the board. The executive director shall serve at the pleasure of the board and shall receive compensation as determined pursuant to section 38-611 to be paid from the board fund. B. The executive director or that person's designee shall: 1. Serve as administrative assistant to the board and manage the board's offices. 2. Collect all monies due and payable to the board. 3. Deposit, pursuant to sections 35-146 and 35-147, all monies received by the board in the appropriate fund. 4. Pay all bills for authorized board expenditures. 5. Administer oaths. 6. Act as custodian of the board's seal and books. 7. Employ special consultants or other agents subject to title 41, chapter 4, article 4 to make investigations, gather information, review complaints, review malpractice claims, suits and settlements, prepare reports and perform other duties the executive director determines are necessary to enforce this chapter. 8. Subject to title 41, chapter 4, article 4 and, as applicable, articles 5 and 6, employ, evaluate, dismiss, discipline and direct professional, clerical, technical, investigative and administrative personnel necessary to carry out the purposes of this chapter. The personnel are eligible to receive compensation pursuant to section 38-611. 9. Issue licenses, limited licenses, registrations, permits, license renewal extensions and waivers to applicants who meet the requirements of this chapter. 10. Enter into contracts pursuant to title 41, chapter 23 for goods and services that are necessary to carry out board policies and directives. 11. Prepare minutes, reports and records of all board transactions and orders. 12. Prepare a biannual budget. 13. As directed by the board, prepare and submit recommendations for changes to this chapter for consideration by the legislature. 14. Initiate an investigation if evidence appears to demonstrate that a physician may be engaged in unprofessional conduct or may be mentally incompetent or physically unable to safely practice medicine. 15. Issue subpoenas to compel the attendance and testimony of a witness and the production of evidence. 16. As directed by the board, provide assistance to the attorney general in preparing and executing disciplinary orders, rehabilitation orders and notices of hearings. 17. Represent the board with the federal government, other states and jurisdictions of the United States, this state, political subdivisions of this state, the news media and the public. 18. If delegated by the board, dismiss complaints that, after an investigation, demonstrate insufficient evidence that the physician's conduct violated this chapter. 19. If delegated by the board, enter into a stipulated agreement with a licensee for the treatment, rehabilitation and monitoring of the licensee's abuse or misuse of a chemical substance. 20. Review all complaints filed pursuant to section 32-1855. If delegated by the board, the executive director may also dismiss a complaint if the complaint is without merit. The executive director shall not dismiss a complaint if a court has entered a medical malpractice judgment against a physician. The executive director shall submit to the board a report of each complaint the executive director dismisses for its review at its next regular board meeting. The report shall include the complaint number, the name of the physician and the investigation timeline for each dismissed complaint. 21. If delegated by the board, refer complaints for an investigative hearing. 22. If delegated by the board, close complaints resolved through mediation. 23. If delegated by the board, issue letters of concern or orders for nondisciplinary education, or both. 24. If delegated by the board, enter into a consent agreement if there is evidence of danger to the public health and safety. 25. If delegated by the board, grant uncontested requests for cancellation of a license pursuant to section 32-1827. 26. Perform any other duty required by the board. 32-1805. Board fund; disbursements (L24, Ch. 222, sec. 25. Eff. until 7/1/28) A. Before the end of the calendar month, pursuant to sections 35-146 and 35-147, the board shall deposit fifteen percent of all monies received by the board from fees and other monies provided for in section 32-1826 in the state general fund and deposit the remaining eighty-five percent in the board fund. All monies derived from civil penalties collected pursuant to section 32-1855 shall be deposited, pursuant to sections 35-146 and 35-147, in the state general fund. B. Monies deposited in the board fund shall be subject to section 35-143.01. 32-1805. Board fund; disbursements (L24, Ch. 222, sec. 26. Eff. 7/1/28) A. Before the end of the calendar month, pursuant to sections 35-146 and 35-147, the board shall deposit ten percent of all monies received by the board from fees and other monies provided for in section 32-1826 in the state general fund and deposit the remaining ninety percent in the board fund. All monies derived from civil penalties collected pursuant to section 32-1855 shall be deposited, pursuant to sections 35-146 and 35-147, in the state general fund. B. Monies deposited in the board fund shall be subject to section 35-143.01. 32-1806. Jurisdiction arbitration panel A. When the board receives a complaint concerning a physician who is also licensed pursuant to chapter 29 of this title, the board shall immediately notify the board of homeopathic and integrated medicine examiners. If the boards disagree and if both boards continue to claim jurisdiction over the dual licensee, an arbitration panel shall decide jurisdiction pursuant to section 32-2907, subsections B, C, D and E. B. If the licensing boards decide without resorting to arbitration which board or boards shall conduct the investigation, the board or boards conducting the investigation shall transmit all investigation materials, findings and conclusions to the other board with which the physician is licensed. The board or boards shall review this information to determine if disciplinary action shall be taken against the physician. 32-1807. Preceptorship awareness campaign; definitions A. The board shall develop a preceptorship awareness campaign that educates medical professionals who are licensed pursuant to this chapter on how to become and the benefits of being a medical preceptor for students. B. For the purposes of this section: 1. "Medical preceptor" means a medical professional who is licensed pursuant to this chapter and who maintains an active practice in this state. 2. "Preceptorship": (a) Means a mentoring experience in which a medical preceptor provides a program of personalized instruction, training and supervision to a student, which may include educating the student about dispensing drugs and devices, to enable the student to obtain a medical professional degree to become licensed pursuant to this chapter. (b) Does not include mentoring for medical services that are prescribed in section 36-2301.01, subsection C, paragraph 1. 3. "Student" means an individual who is matriculating at the graduate level at an accredited institution of higher education in this state and who is seeking a medical professional degree to become licensed pursuant to this chapter. 32-1821. Persons and acts not affected by chapter This chapter does not prevent: 1. A duly licensed physician and surgeon of any other state, district or territory from meeting a person licensed pursuant to this chapter within this state for consultation or, pursuant to an invitation by a sponsor, visiting this state for the sole purpose of promoting professional education through lectures, clinics or demonstrations as long as the visiting physician does not open an office, designate a place to meet patients or receive calls relating to the practice of medicine outside of the facilities and programs of the sponsor. 2. The practice of any other method, system or science of healing by a person duly licensed pursuant to the laws of this state. 3. The practice by physicians and surgeons discharging their duties while members of the armed forces of the United States or other federal agencies. 4. Any act, task or function performed by a physician assistant or registered nurse practitioner in the proper discharge of that person's duties. 5. A person administering a lawful domestic or family remedy to a member of that person's immediate family. 6. Providing medical assistance in case of an emergency. 7. The emergency harvesting of donor organs. 32-1822. Qualifications of applicant; application; fingerprinting; fees A. On a form and in a manner prescribed by the board, an applicant for licensure shall submit proof that the applicant: 1. Is the person named on the application and on all supporting documents submitted. 2. Is a citizen of the United States or a resident alien. 3. Is a graduate of a school of osteopathic medicine approved by the American osteopathic association. 4. Has successfully completed an approved internship, the first year of an approved multiple-year residency or a board-approved equivalency. 5. Has passed the approved examinations for licensure within seven years of application or has the board-approved equivalency of practice experience. 6. Has not engaged in any conduct that, if it occurred in this state, would be considered unprofessional conduct or, if the applicant has engaged in unprofessional conduct, is rehabilitated from the underlying conduct. 7. Is physically, mentally and emotionally able to practice medicine, or, if limited, restricted or impaired in the ability to practice medicine, consents to contingent licensure pursuant to subsection E of this section or to entry into a program prescribed in section 32-1861. 8. Has submitted a full set of fingerprints to the board for the purpose of obtaining a state and federal criminal records check pursuant to section 41-1750 and Public Law 92-544. The department of public safety may exchange this fingerprint data with the federal bureau of investigation. B. An applicant must submit with the application the nonrefundable application fee prescribed in section 32-1826 and pay the prescribed license issuance fee to the board at the time the license is issued. C. The board or the executive director may require an applicant to submit to a personal interview, a physical examination or a mental evaluation or any combination of these, at the applicant's expense, at a reasonable time and place as prescribed by the board if the board determines that this is necessary to provide the board adequate information regarding the applicant's ability to meet the licensure requirements of this chapter. An interview may include medical knowledge questions and other matters that are relevant to licensure. D. The board may deny a license for any unprofessional conduct that would constitute grounds for disciplinary action pursuant to this chapter or as determined by a competent domestic or foreign jurisdiction. E. The board may issue a license that is contingent on the applicant entering into a stipulated order that may include a period of probation or a restriction on the licensee's practice. F. The executive director may issue licenses to applicants who meet the requirements of this section. G. A person whose license has been revoked, denied or surrendered in this or any other state may apply for licensure not sooner than five years after the revocation, denial or surrender. H. A license issued pursuant to this section is valid for the remainder of the calendar year in which it was issued, at which time it is eligible for renewal. 32-1823. Locum tenens registration; application; term; interview; denial of application; discipline A. A doctor of osteopathy who is licensed to practice osteopathic medicine and surgery by another state may be registered to provide locum tenens medical services to substitute for or temporarily assist a doctor of osteopathy who holds an active license pursuant to this chapter or a doctor of medicine who holds an active license pursuant to chapter 13 of this title under the following conditions: 1. The applicant provides on forms and in a manner prescribed by the board proof that the applicant meets the applicable requirements of section 32-1822. 2. The doctor of medicine or doctor of osteopathy for whom the applicant is substituting or assisting provides to the board a written request for locum tenens registration of the applicant. B. On completion of the registration form prescribed by the board and payment of the required fees, the executive director may register a qualifying doctor of osteopathy by locum tenens registration and authorize the doctor to provide locum tenens services. C. Locum tenens registration granted pursuant to this section is valid for ninety days and may be extended once for an additional ninety days on written request by the doctor of medicine or doctor of osteopathy who originally initiated the request for this registration, stating the reason extension is necessary, and by submitting the appropriate fees and other documents requested by the executive director. D. The board or the executive director may require an applicant to submit to a personal interview to provide the board with adequate information regarding the applicant's ability to practice under locum tenens registration. The applicant is responsible for all costs to attend the interview. E. The board may deny the application for a locum tenens registration for any unprofessional conduct that would constitute grounds for disciplinary action pursuant to this chapter or as determined by a competent domestic or foreign jurisdiction. F. A locum tenens registrant is subject to the disciplinary provisions pursuant to this chapter. 32-1824. Expedited licensure; medical licensure compact; fingerprinting Beginning September 1, 2017, applicants for expedited licensure pursuant to section 32-3241 shall submit a full set of fingerprints to the board for the purpose of obtaining a state and federal criminal records check pursuant to section 41-1750 and Public Law 92-544. The department of public safety may exchange this fingerprint data with the federal bureau of investigation. Communication between the board and the interstate medical licensure compact commission regarding verification of physician eligibility for licensure under the medical licensure compact may not include any information received from the federal bureau of investigation relating to a state and federal criminal records check performed for the purposes of section 32-3241, section 5, subsection B, paragraph 2. 32-1825. Renewal of licenses; continuing medical education; failure to renew; penalty; reinstatement; waiver of continuing medical education A. Except as provided in section 32-4301, each licensee shall renew the license every other year on or before January 1 on an application form approved by the board. At least sixty days before that renewal date, the executive director shall notify each licensee of this requirement. The executive director shall send this notification by mail to the licensee at the licensee's address. B. With the application prescribed pursuant to subsection A of this section, the licensee shall furnish to the executive director a statement of having attended before the license renewal date educational programs, approved by the board, totaling at least forty clock hours during the two preceding years, and a statement that the licensee reported any conduct that may constitute unprofessional conduct in this state or elsewhere. The application must also include the prescribed renewal fee. The executive director shall then issue a renewal receipt to the licensee. The board may require a licensee to submit documentation of continuing medical education. C. The board shall not renew the license of a licensee who does not fully document the licensee's compliance with the continuing education requirements of subsection B of this section unless that person receives a waiver of those requirements. The board may waive the continuing education requirements of subsection B of this section for a particular period if it is satisfied that the licensee's noncompliance was due to the licensee's disability, military service or absence from the United States or to other circumstances beyond the control of the licensee. If a licensee fails to attend the required number of clock hours for reasons other than those specified in this subsection, the board may grant an extension until May 1 of that year for the licensee to comply. D. Unless the board grants an extension pursuant to subsection C of this section, a licensee who fails to renew the license within thirty days after the renewal date shall pay a penalty fee and a reimbursement fee in addition to the prescribed renewal fee. Except as provided in sections 32-3202 and 32-4301, a license expires if a person does not renew the license within four months after the renewal date. A person who practices osteopathic medicine after that time is in violation of this chapter. A person whose license expires may reapply for a license pursuant to this chapter. 32-1826. Fees; penalty A. The board shall establish fees of not to exceed the following: 1. For an application to practice osteopathic medicine, four hundred dollars. 2. For issuance of a license, two hundred dollars, prorated by each month remaining in the calendar year of issuance. 3. For biennial renewal of a license, eight hundred dollars. 4. For locum tenens registration or extension, three hundred dollars. 5. For issuance of a duplicate license, one hundred dollars. 6. For an annual training permit for an approved postgraduate training program or short-term residency program, one hundred dollars. 7. For an annual teaching license issued pursuant to section 32-1831, four hundred dollars. 8. For a five-day educational teaching permit at an approved school of medicine or at an approved teaching hospital's accredited graduate medical education program, two hundred dollars. 9. For the sale of a computerized format of the board's licensee directory that does not require programming, one hundred dollars. 10. For initial and annual registration to dispense drugs and devices, two hundred fifty dollars, prorated by each month remaining in the calendar year of issuance. B. The board shall charge a one hundred fifty dollar penalty fee for late renewal of a license and a twenty-five dollar reimbursement fee to cover the board's expenses in collecting late renewal fees. The board shall deposit this fee in the board fund. C. The board may charge additional fees for services the board determines are necessary and appropriate to carry out this chapter. These fees shall not exceed the actual cost of providing the services. 32-1827. Cancellation of a license; requirements The board shall cancel a license at the licensee's request if the licensee is not the subject of a board investigation or disciplinary proceeding. 32-1828. Education teaching permits A. The dean of a school of osteopathic medicine approved by the American osteopathic association or the chairman of a teaching hospital's accredited graduate medical education program may invite a doctor of osteopathy who is not licensed in this state to demonstrate and perform medical procedures and surgical techniques for the sole purpose of promoting professional education for students, interns, residents, fellows and doctors of osteopathy in this state. B. The chairman or dean of the inviting institution shall provide to the board evidence that an applicant for an educational permit has malpractice insurance in an amount that meets the requirements of that institution and that the applicant accepts all responsibility and liability for the procedures the applicant performs within the scope of the applicant's permit. C. In a letter to the board, the chairman or dean of the inviting institution shall outline the procedures and techniques that the doctor of medicine will perform or demonstrate and the dates that this activity will occur. The letter shall also include a summary of the doctor of osteopathy's education and professional background and shall be accompanied by the fee required pursuant to this chapter. D. The inviting institutions shall submit the fees and documents required pursuant to this section no later than two weeks before the scheduled activity. E. The board through its staff shall issue an educational teaching permit for not more than five days for each approved activity. 32-1829. Training permits; issuance of permits A. The board may grant a one-year renewable training permit to a person who is participating in a teaching hospital's accredited internship, residency or clinical fellowship training program to allow that person to practice medicine only in the supervised setting of that program. Before the board issues the permit, the person shall: 1. Submit an application on a form and in a manner prescribed by the board and proof that the applicant: (a) Is the person named on the application and on all supporting documentation. (b) Is a citizen of the United States or a resident alien. (c) Is a graduate of a school approved by the American osteopathic association. (d) Participated in postgraduate training, if any. (e) Has passed approved examinations appropriate to the applicant's level of education and training. (f) Has not engaged in any conduct that, if it occurred in this state, would be considered unprofessional conduct or, if the applicant has engaged in unprofessional conduct, is rehabilitated from the underlying conduct. (g) Is physically, mentally and emotionally able to practice medicine, or, if limited, restricted or impaired in the ability to practice medicine, consents to a contingent permit or to entry into a program described in section 32-1861. 2. Pay the nonrefundable application fee prescribed by the board. B. If a permittee who is participating in a teaching hospital's accredited internship, residency or clinical fellowship training program must repeat or make up time in the program due to resident progression or for other reasons, the board may grant that person an extension of the training permit if requested to do so by the program's director of medical education or a person who holds an equivalent position. The extended permit limits the permittee to practicing only in the supervised setting of that program for a period of time sufficient to repeat or make up the training. C. The board may grant a training permit to a person who is not licensed in this state and who is participating in a short-term training program of four months or less for continuing medical education conducted in an approved school of osteopathic medicine or a hospital that has an accredited hospital internship, residency or clinical fellowship training program in this state. Before the board issues the permit, the person shall: 1. Submit an application on a form and in a manner prescribed by the board and proof that the applicant meets the requirements prescribed in subsection A, paragraph 1 of this section. 2. Pay the nonrefundable application fee prescribed by the board. D. A permittee is subject to the disciplinary provisions of this chapter. E. The executive director may issue a permit to an applicant who meets the requirements of this chapter. F. If a permit is not issued pursuant to subsection E of this section, the board may issue a permit or may: 1. Issue a permit that is contingent on the applicant entering into a stipulated agreement that may include a period of probation or a restriction on the permittee's practice. 2. Deny a permit to an applicant who does not meet the requirements of this chapter. 32-1829.01. Osteopathic graduate transitional training permit; requirements; definitions A. The board or, if delegated, the executive director of the board shall grant a one-year transitional training permit to a graduate of an osteopathic school of medicine who is not otherwise eligible to apply for a license to practice or a training permit pursuant to section 32-1829 or 32-1830 in this state if the applicant meets both of the following conditions: 1. Within a two-year period immediately preceding initial application for a transitional training permit, was either: (a) Qualified to submit, and submitted, a valid application to an accredited internship or residency program but was not selected for a position. (b) Selected for a position described in subdivision (a) of this paragraph but ended participation in the program before completion for a reason that would not be considered grounds for disciplinary action pursuant to section 32-1855. 2. Successfully completed steps one and two of the United States medical licensing examination or equivalent steps of the comprehensive osteopathic medical licensing examination. B. The transitional training permit may be renewed for two additional one-year periods if the permittee, in the year preceding an application for renewal, submits complete and valid applications to at least three accredited primary care internship or residency programs and is not selected for an internship or residency position. The permittee shall provide the board with written documentation of the internship or residency program applications and the nonselections. A permittee may not hold a permit for an aggregate time period of more than thirty-six months. C. The transitional training permit limits the permittee to function only under the supervision of a qualified physician within the setting of an eligible entity, which includes the following if located in this state: 1. A hospital or behavioral health facility that is licensed pursuant to title 36, chapter 4. 2. A patient care facility operated by or for any federally recognized American Indian tribe, the Indian health service, the United States veterans administration, a prison or a school or university. 3. A community health center or a federally qualified health center. 4. A private office or clinic where a supervising qualified physician practices and that is not a pain management clinic as defined in section 36-448.01. D. An eligible entity contracting with or employing a permittee shall: 1. Provide to the permittee, in collaboration with the supervising qualified physician, ongoing clinical training related to the services that may be delegated to the permittee by the supervising qualified physician. 2. Be responsible, along with the supervising qualified physician, for all aspects of the performance of a permittee. 3. Ensure that the health care tasks performed by a permittee are within the permittee's scope of medical training, experience and competence and have been properly delegated and supervised by a qualified physician. 4. Ensure that during the permittee's first six months of full-time practice, all clinical encounters performed by the permittee are under the direct supervision of the supervising qualified physician. Subsequent encounters performed by the permittee after the initial six-month period may be under indirect supervision with direct supervision immediately available from the supervising qualified physician. 5. Ensure that all qualified physician supervision is documented. 6. Ensure that in all clinical or other patient encounters the permittee is clearly identified as a medical graduate in training. 7. Define the employment or contractual relationship with the permittee, including terms of compensation and benefits, billing and reimbursement and general and professional liability coverage. 8. Establish and document a process for evaluating the permittee's performance that includes a review by the supervising qualified physician of all medical records related to the clinical encounters performed by the permittee. E. The supervising qualified physician may delegate to a permittee the performance of health care tasks that are of a nature typically delegated in an accredited internship or residency program, including the ability to provide delegated telehealth services that are of a similar nature, if all other conditions prescribed in this section are met. F. Before employing or contracting with a permittee, an eligible entity shall notify the department of health services on a form prescribed by the department, or on an equivalent form from the entity, of all the following information: 1. The types and extent of medical training the entity plans to provide to the permittee. 2. The names of the qualified physicians who will supervise the permittee and the types of health care tasks that may be delegated to the permittee by those supervising qualified physicians. G. An eligible entity shall post on its public website and submit to the department an annual report that includes all of the following: 1. The number of permittees and supervising qualified physicians employed by or contracted with the entity. 2. The length of time each permittee and supervising qualified physician has been employed by or contracted with the entity. 3. The total number of hours of medical education provided to each permittee. 4. The total number of hours of clinical care provided by each permittee. 5. The number of permittees who obtained a match with an accredited internship or residency program. H. Before supervising a permittee, a qualified physician shall notify the board in writing of the qualified physician's agreement to serve as a supervising qualified physician. The notification shall include the name of the permittee and the name and location of the eligible entity at which the supervision will occur. I. Before the board issues or renews a training permit under this section, the applicant or renewing permittee shall comply with the applicable registration requirements of this article and pay the fee, which shall be the same as the fee prescribed for an approved internship pursuant to section 32-1826. J. This section does not require any eligible entity or qualified physician to establish a program to employ or contract with permittees as described in this section or require any qualified physician to assume supervision responsibilities for a permittee. K. A permittee under this section: 1. Is subject to the disciplinary regulation of article 3 of this chapter. 2. Per one-year period, shall participate in at least sixty hours of continuing medical education programs approved by the board. 3. Shall notify the board on the permittee's acceptance to an accredited internship or residency program. L. A supervising qualified physician under this section: 1. Is responsible for all aspects of a permittee's performance, whether or not the supervising qualified physician employs the permittee. 2. Is responsible for supervising the permittee and ensuring that the health care tasks performed by the permittee are within the permittee's scope of medical training and experience, are appropriate to the permittee's level of competence and are properly delegated by the supervising qualified physician. 3. May allow a permittee to administer or dispense drugs under the conditions of section 32-1871 if the controlled substance permit under which the drugs are dispensed is either the supervising qualified physician's or the eligible entity's permit. 4. May serve as a supervising qualified physician for only one permittee at any one time. 5. Shall notify the board, the eligible entity and the permittee in writing if the permittee exceeds the scope of the delegated health care tasks to allow the board to investigate. M. For the purposes of this section: 1. "Direct supervision" means the supervising qualified physician is physically present with the permittee and patient. 2. "Indirect supervision with direct supervision immediately available" means the supervising qualified physician is physically present within the hospital or other eligible entity site of patient care and is immediately available to provide direct supervision of the permittee. 3. "Permittee" means a person who holds a transitional training permit issued pursuant to this section. 4. "Qualified physician" means a physician who possesses a full and unrestricted license issued pursuant to this chapter to engage in the practice of medicine in this state and who is not currently under board discipline. 32-1830. Training permits; approved schools The executive director may grant a one-year training permit to a person who: 1. Participates in a program at an approved school of medicine or a hospital that has an approved hospital internship, residency or clinical fellowship training program if the purpose of the program is to exchange technical and educational information. 2. Pays the fee as prescribed by the board. 3. Submits a written statement from the dean of the approved school of osteopathic medicine or from the chairman of a teaching hospital's accredited graduate medical education program that: (a) Includes a request for the permit and describes the purpose of the exchange program. (b) Specifies that the host institution shall provide liability coverage. (c) Provides proof that a doctor of medicine will serve as the preceptor of the host institution and provide appropriate supervision of the participant. (d) States that the host institution has advised the participant that the participant may serve as a member of an organized medical team but shall not practice medicine independently and that this training does not accrue toward postgraduate training requirements for licensure. 32-1831. Teaching licenses; definitions A. A doctor of osteopathic medicine who is not licensed in this state may be employed as a full-time faculty member by a school of osteopathic medicine in this state approved by the American osteopathic association or a teaching hospital's accredited graduate medical education program in this state to provide professional education through lectures, clinics or demonstrations if the doctor holds a teaching license issued pursuant to this section. B. An applicant for a teaching license shall: 1. Submit a completed application as prescribed by the board. 2. Pay all fees prescribed by the board. Application fees are nonrefundable. 3. Meet the requirements of section 32-1822. C. A person who is licensed pursuant to this section shall not open an office or designate a place to meet patients or receive calls relating to the practice of osteopathic medicine in this state outside of the facilities and programs of the approved school or teaching hospital. D. A person who is licensed pursuant to this section shall comply with the requirements of this chapter, with the exception of those that relate to licensing examinations. E. The board or the executive director may require an applicant to submit to a personal interview, a physical examination or a mental health evaluation, or any combination of these, at the applicant's expense. The board shall prescribe a reasonable time and place if the board determines that this is necessary to provide the board with adequate information regarding the applicant's ability to meet the licensure requirements of this chapter. The interview may include questions regarding medical knowledge and other matters relevant to licensure. F. The board may deny a license for any unprofessional conduct that would constitute grounds for disciplinary action pursuant to this chapter or as determined by a competent domestic or foreign jurisdiction. G. A person who is licensed pursuant to this section is subject to the disciplinary provisions pursuant to this chapter. H. A license issued pursuant to this section is valid for two years. A doctor of osteopathic medicine may apply for licensure once every two years, subject to the continuing medical education requirements prescribed in section 32-1825. I. For the purposes of this section: 1. "Accredited" means that the school or teaching hospital has an internship, fellowship or residency training program that is accredited by the accreditation council for graduate medical education, the American osteopathic association or a similar body that is approved by the board. 2. "Full-time faculty member" means a full-time faculty member as prescribed by the school of osteopathic medicine or the teaching hospital. 32-1832. Retired license; waiver of fees; reinstatement; limited license; volunteer work A. The board shall waive a physician's biennial renewal fee if the physician has paid all past fees, presents an affidavit to the board stating that the physician has permanently retired from the practice of osteopathic medicine and does not have any pending complaints or open disciplinary matters before the board. B. A retired physician whose biennial fee has been waived by the board pursuant to this section is not required to comply with any continuing medical education requirements of this chapter. C. After retired status is granted by the board, a retired physician shall submit a renewal of retired status every two years on a form and in a manner prescribed by the board. D. Except as provided in subsection F of this section, a retired physician who has had the biennial renewal fee waived by the board pursuant to this section and who engages in the practice of osteopathic medicine is subject to the same penalties that are imposed pursuant to this chapter on a person who practices medicine without a license or without being exempt from licensure. E. The board may reinstate a retired physician to active status on payment of the biennial renewal fee and presentation of evidence satisfactory to the board that the physician meets the qualifications prescribed pursuant to section 32-1822. The board may deny the request for reinstatement, place the licensee on probation or issue a limited license that requires general or direct supervision by another licensed doctor of osteopathy for not more than one year. F. A retired physician who has had the biennial renewal fee waived by the board pursuant to this section may perform volunteer work of not more than ten hours each week and may teach or provide instruction at an approved school of osteopathic medicine. 32-1833. Pro bono registration A. The board may issue a pro bono registration to allow a doctor of osteopathy who is not a licensee to practice in this state for a total of sixty days each calendar year if the doctor meets all of the following requirements: 1. Holds an active and unrestricted license to practice medicine in a state, territory or possession of the United States. 2. Has never had a license revoked or suspended by a health profession regulatory board of another jurisdiction. 3. Is not the subject of an unresolved complaint. 4. Applies for registration on an annual basis as prescribed by the board. 5. Agrees to render all medical services without accepting a fee or salary or performs only initial or follow-up examinations at no cost to the patient and the patient's family through a charitable organization. B. The sixty days of practice prescribed pursuant to subsection A of this section may be performed consecutively or cumulatively during each calendar year. C. For the purpose of meeting the requirements of subsection A of this section, an applicant under this section shall provide the board the name of each state in which the person is licensed or has held a license. The board shall verify with the applicable regulatory board of each state that the applicant is licensed or has held a license, has never had a license revoked or suspended and is not the subject of an unresolved complaint. The board may accept the verification of the information required by subsection A, paragraphs 1, 2 and 3 of this section from each of the other state's regulatory boards either electronically or by hard copy. 32-1834. Temporary licensure; requirements; fee A. Beginning July 1, 2017, the board may issue a temporary license, which may not be renewed or extended, to allow a physician who is not a licensee to practice in this state for a total of up to two hundred fifty consecutive days if the physician meets all of the following requirements: 1. Holds an active and unrestricted license to practice medicine in a state, territory or possession of the United States. 2. Has never had a license revoked or suspended or surrendered a license for disciplinary reasons. 3. Is not the subject of an unresolved complaint. 4. Has applied for a license pursuant to section 32-1822. 5. Has paid any applicable fees. B. The physician shall submit to the board a notarized affidavit attesting that the physician meets the requirements of subsection A, paragraphs 1, 2 and 3 of this section. The physician shall notify the board immediately if any circumstance specified in subsection A, paragraphs 1, 2 and 3 of this section changes during the application period for a temporary license or while holding a temporary license, at which time the board may deny or revoke the temporary license. C. The board shall approve or deny an application under this section within thirty days after an applicant files a complete application. The approval of a temporary license pursuant to this section allows the physician to practice in this state without restriction. D. If granted, the physician's temporary license expires the earlier of two hundred fifty days after the date the temporary license is granted or on approval or denial of the physician's license application submitted pursuant to section 32-1822. E. For the purpose of meeting the requirements of subsection A of this section, an applicant shall provide the board the name of each state, territory or possession of the United States in which the person is licensed or has held a license and the board shall verify with the applicable regulatory board that the applicant holds an active and unrestricted license to practice medicine, has never had a license revoked or suspended or surrendered a license for disciplinary reasons and is not the subject of an unresolved complaint. The board may accept the verification of this information from each other regulatory board verbally, which shall be followed by either an electronic or hard copy before the physician's permanent license is granted. If the board is unable to verify the information within the initial thirty days as required by subsection C of this section, the board may extend the time frame by an additional thirty days to receive the necessary verification. F. The board may establish a fee in rule for temporary licensure under this section. 32-1835. Specialty certification; prohibited requirement for licensure; definition A. The board may not require an applicant for licensure pursuant to this article to hold or maintain a specialty certification as a condition of licensure in this state. This subsection does not prohibit the board from considering an applicant's specialty certification as a factor in whether to grant a license to the applicant. B. For the purposes of this section, "specialty certification" means certification by a board that specializes in one particular area of medicine and that may require examinations in addition to those required by this state to be licensed to practice medicine. 32-1851. Prohibited acts The following acts are prohibited: 1. Practicing medicine and surgery as an osteopathic physician and surgeon without holding a license issued by the board under the provisions of this chapter. 2. Misusing the designation "D.O." in a way that leads the public to believe that a person is licensed to practice medicine in this state. 3. Using the designation "doctor of osteopathy", "doctor of osteopathic medicine", "osteopathic physician", "osteopathic surgeon", "osteopathic physician and surgeon" or any combination of these terms unless the designation additionally contains the description of another branch of the healing arts. 4. Using any other words, initials or symbols or a combination of these that leads the public to believe a person is licensed to practice medicine in this state. 32-1852. Rights and duties of osteopathic physicians and surgeons; scope of practice A person holding a license under this chapter to practice medicine and surgery as an osteopathic physician and surgeon shall be subject to all state and local laws and regulations pertaining to public health. In diagnosticating, prognosticating and treating any human ills he shall be subjected to all the same duties and obligations and authorized to exercise all the same rights and privileges possessed by physicians and surgeons of other complete schools of medicine in the practice of their profession. 32-1853. Use of title A person licensed under this chapter shall use the title "osteopathic physician and surgeon", "osteopathic physician" or "doctor of osteopathy" or affix the initials "D.O." after the licensee's name. 32-1853.01. Use of title by a medical assistant It is unlawful for a person to use the title "medical assistant" or a related abbreviation unless the person is working as a medical assistant under the supervision of a doctor of osteopathic medicine pursuant to rules adopted by the board or possesses written verification of successful completion of a training program provided pursuant to rules adopted by the board. 32-1854. Definition of unprofessional conduct For the purposes of this chapter, "unprofessional conduct" includes the following acts, whether occurring in this state or elsewhere: 1. Knowingly betraying a professional secret or wilfully violating a privileged communication except as either of these may otherwise be required by law. This paragraph does not prevent members of the board from exchanging information with the licensing and dis