1. 1. From the applicant, the following items:

   1. a. AHCCCS provider registration form;
   2. b. Documentation of current CPR and First Aid training, current driver’s license, and applicable professional licenses and certifications, if prior documentation has expired;
   3. c. A completed declaration of criminal history every three years since the date of initial certification; and
   4. d. Documentation that fingerprints have been taken at three-year intervals.
2. 2. From sources other than the applicant, documentation that the applicant’s home or office has passed a fire inspection every two years since the date of initial certification.

A renewal application is complete when the Division has all the following information:

Historical Note

Adopted effective February 1, 1998 (Supp. 98-1).