Ga. Comp. R. & Regs. r. 360-40-.03
Rule 360-40-.03. Applicants Applying for Licensure to Georgia through IMLC
2. Applicants must have a Letter of Qualification (LOQ) to qualify for licensure from their principal home state. The Letter of Qualifications will be valid for 365 days from the date of issue. In addition to the LOQ must provide the following additional information within 30 days of licensure:
* Your current CV or resume (also, provide information for any date gaps in the CV or resume)
* Form B, Reference Form (three references are required)
* Form D, Affidavit of Applicant
* Form D2, Affidavit for Medical Board License
* A copy of a secure and verifiable document from the list following Form
* Form E, Malpractice Questionnaire, including documentation of any cases
* National Practitioner Data Bank (NPDB) and Health Integrity and Protection Data Bank (HIPDB) Self-Query and Reports, if you have ever held a license in the US or Canada (not including training licenses). Order it at https://www.npdb-hipdb.hrsa.gov/ext/RulesOfBehaviorSQ.jsp?SUBJECT_TYPE=I.
* Military discharge documentation, if you have ever been discharged from US military service.
* Form G, Specific Power of Attorney, if you want to authorize anyone else to make inquiries about your application.
Authority: O.C.G.A. §§ 43-34-28, 43-34-300, 43-34-301, 43-34-302, 43-34-303.
History. Original Rule entitled "Applicants Applying for Licensure to Georgia through IMLC" adopted. F. Jan. 4, 2021; eff. Jan. 24, 2021.