1. A. A Board shall establish a process for requesting the information in subsection (B):

   1. 1. From an individual applying for an initial license, certification, or registration, at the time of application; and
   2. 2. From an individual regulated by the Board, in compliance with A.R.S. § 32-3249.01(A).

2. B. A Board shall request the following information about an individual, in a Department-provided format:

   1. 1. The individual’s name;
   2. 2. The individual’s date of birth;
   3. 3. The individual’s gender;
   4. 4. The individual’s race and ethnicity;
   5. 5. If applicable, the individual’s National Provider Number;
   6. 6. Whether the individual is able to provide services to patients or clients in a language other than English and, if so, in which languages;
   7. 7. The type of license, certification, or registration held by the individual or for which the individual is applying;
   8. 8. The individual’s professional license, registration, or certification number, if applicable;
   9. 9. The beginning and end date of the individual’s current license, certification, or registration, if applicable;
   10. 10. The individual’s highest level of training or education related to the individual’s license, certification, or registration;
   11. 11. The individual’s highest level of education in another field;
   12. 12. The individual’s current employment status;

   13. 13. Whether the individual is currently providing direct patient care related to the individual’s license, certification, or registration, as applicable, on a regular basis in Arizona and, if so:

       1. a. The zip code of the individual’s primary practice location;
       2. b. The type of facility in which the individual is providing direct patient care at the primary practice location;
       3. c. The number of weeks worked over the previous 12 months at the primary practice location;

       4. d. The average hours worked per week at the primary practice location, including the percentage of time spent in:

          1. i. Direct patient care;
          2. ii. Administration, including any paperwork not part of direct patient care;
          3. iii. Research;
          4. iv. Teaching or education; or
          5. v. Other specified activities;
       5. e. Whether the individual expects a change in subsection (B)(13)(b), (c), or (d) in the next 12 months; and
       6. f. If the individual expects to reduce the time spent providing direct patient care in the next 12 months, the reason for the change; and
   14. 14. If the individual is a physician, physician assistant, or registered nurse practitioner, whether the individual provides primary care services, as defined in A.A.C. R9-24-201.

Historical Note

New Section made by final rulemaking at 28 A.A.R. 2525 (September 30, 2022), effective November 7, 2022 (Supp. 22-3).