PURPOSE: This rule provides the requirements assistant physicians must follow to request inactive status.

1. (1) Any assistant physician may request that his or her license be put on inactive status by filling out an Inactive Status form provided by the board. The application form shall include at least the following:

   1. (A) Name of the applicant;
   2. (B) Current address, telephone number, and email address;
   3. (C) If not provided at the time of original licensure, the applicant shall provide his or her Social Security number;
   4. (D) The name of the assistant physician’s collaborating physician; and
   5. (E) A statement that the assistant physician acknowledges that he or she can no longer practice.
2. (2) To reactivate any license that has been placed on inactive status for less than six (6) months, the licensee must follow the provisions of 20 CSR 2150-2.210(2).
3. (3) If an assistant physician license is on inactive status for six
4. (6) months or more, it shall be expired and may not be reinstated or renewed.

AUTHORITY: section 324.039, RSMo Supp. 2013, sections 334.036 and 334.125, RSMo. Supp. 2014, and section 334.045, RSMo 2000.* Original rule filed June 29, 2016, effective Jan. 30, 2017. *Original authority: 324.039, RSMo 2008; 334.036, RSMo 2014; 334.045, RSMo 1963, amended 1981, 1987, 1989, 1993, 1995; and 334.125, RSMo 1959, amended 1993, 1995, 2014.