1. A. To request a name change on a midwifery license or a duplicate midwifery license, a midwife shall submit in writing to the Department:

   1. 1. The midwife’s name on the current midwifery license;
   2. 2. If applicable, the midwife’s new name;
   3. 3. The midwife’s address, license number, and e-mail address;

   4. 4. As applicable:

      1. a. Documentation supporting the midwife’s name change, or
      2. b. A statement that the midwife is requesting a duplicate midwifery license; and
   5. 5. A non-refundable fee of $10.00.

2. B. Upon receipt of the written request required in subsection (A), the Department shall issue, as applicable:

   1. 1. An amended midwifery license that incorporates the name change but retains the expiration date of the midwifery license, or
   2. 2. A duplicate midwifery license.

Historical Note

Adopted effective March 14, 1994 (Supp. 94-1). Section R9-16-106 renumbered to R9-16-108; new Section R9-16-106 made by exempt rulemaking at 19 A.A.R. 1805, effective July 1, 2013 (Supp. 13-2).