NAC633.283. Physician assistants: Application for license.

     1. An application for a license as a physician assistant must include, without limitation:

     (a) The date and place of birth of the applicant;

     (b) The gender of the applicant;

     (c) The education of the applicant, including, without limitation, any high school and postsecondary institution attended, the length of time in attendance and whether the applicant is a graduate of those schools and institutions;

     (d) The training and experience of the applicant as a physician assistant;

     (e) Whether the applicant has ever:

          (1) Applied for a license or certificate as a physician assistant in another state and, if so, specification of which state, when the application was made and the results of the application;

          (2) Had a license or certificate as a physician assistant revoked, modified, limited or suspended;

          (3) Been investigated for misconduct as a physician assistant;

          (4) Had any disciplinary action or proceeding instituted against him or her by a licensing body in any jurisdiction;

          (5) Been convicted of a felony or an offense involving moral turpitude; or

          (6) Been investigated for, charged with or convicted of the use or illegal sale or dispensing of a controlled substance; and

     (f) The places of residence of the applicant since the date of his or her graduation from high school or his or her receipt of a high school general equivalency diploma.

     2. An application for a license as a physician assistant must be:

     (a) Signed by the applicant;

     (b) Sworn to before a notary public or other officer authorized to administer oaths; and

     (c) Accompanied by:

          (1) A physician assistant information profile prepared by the Federation Credentials Verification Service of the Federation of State Medical Boards;

          (2) An affidavit affirming that:

               (I) The applicant is the person named in the application and accompanying material; and

               (II) To the best knowledge or belief of the applicant, the application and all accompanying material is complete, correct and consistent, and was obtained without fraud, misrepresentation or mistake; and

          (3) The nonrefundable application and initial license fee prescribed in NAC 633.335.

     3. If it appears to the Board that:

     (a) Any information submitted is false or inconsistent; or

     (b) The application is not made in proper form or other deficiencies appear in it,

Ê the application will be rejected.

     (Added to NAC by Bd. of Osteopathic Med. by R192-07, eff. 12-17-2008; A by R154-09, 10-15-2010)