NAC630.290. Application for license.

     1. An application for licensure as a physician assistant must be made on a form supplied by the Board. The application must state:

     (a) The date and place of the applicant’s birth and his or her sex;

     (b) The applicant’s education, including, without limitation, high schools and postsecondary institutions attended, the length of time in attendance at each and whether he or she is a graduate of those schools and institutions;

     (c) Whether the applicant has ever applied for a license or certificate as a physician assistant in another state and, if so, when and where and the results of his or her application;

     (d) The applicant’s training and experience as a physician assistant;

     (e) Whether the applicant has ever been investigated for misconduct as a physician assistant or had a license or certificate as a physician assistant revoked, modified, limited or suspended or whether any disciplinary action or proceedings have ever been instituted against the applicant by a licensing body in any jurisdiction;

     (f) Whether the applicant has ever been convicted of a felony or an offense involving moral turpitude;

     (g) Whether the applicant has ever been investigated for, charged with or convicted of the use or illegal sale or dispensing of controlled substances; and

     (h) The various places of his or her residence from the date of:

          (1) Graduation from high school;

          (2) Receipt of a high school general equivalency diploma; or

          (3) Receipt of a postsecondary degree,

Ê whichever occurred most recently.

     2. An applicant must submit to the Board:

     (a) Proof of completion of an educational program as a physician assistant:

          (1) If the applicant completed the educational program on or before December 31, 2001, which was approved by the Committee on Allied Health Education and Accreditation or the Commission on Accreditation of Allied Health Education Programs; or

          (2) If the applicant completed the educational program on or after January 1, 2002, which is accredited by the Accreditation Review Commission on Education for the Physician Assistant or approved by the Commission on Accreditation of Allied Health Education Programs;

     (b) Proof of passage of the examination given by the National Commission on Certification of Physician Assistants; and

     (c) Such further evidence and other documents or proof of qualifications as required by the Board.

     3. Each application must be signed by the applicant and sworn to before a notary public or other officer authorized to administer oaths.

     4. The application must be accompanied by the applicable fee.

     5. An applicant shall pay the reasonable costs of any examination required for licensure.

     [Bd. of Medical Exam’rs, § 630.290, eff. 12-20-79]—(NAC A 6-23-86; 9-12-91; 1-13-94; 11-3-95; 7-18-96; R149-97, 3-30-98; R007-99, eff. 9-27-99; R108-01, 11-29-2001; R145-03, 12-16-2003)