1. (a) Applicants for licensure as a physician assistant shall complete and submit:

   1. (1) The information described in Plc 304.03 on the “Universal Application for Initial Licensure”; and

   2. (2) The following information specific to the board of medicine:

      1. a. Place of birth;
      2. b. A statement that the applicant has arranged for the direct submission of one letter of reference from a physician and one letter of reference from either a physician or physician assistant, who have served in an advisory capacity to the applicant;
      3. c. A list of all names the applicant has ever been known by; and
      4. d. A 2 x 2 passport photograph of the applicant taken within 6 months of submission of the application.
2. (b) The applicant shall sign and date the application as described in Plc 304.05.
3. (c) Applicants shall include the application fee required by Plc 1002.28.

4. (d) The applicant shall provide the following with the application

   1. (1) Documentation of completion of an educational program in the form of a letter directly from the educational institution;

   2. (2) Unless the information sought is available only on a website, an official letter of verification sent directly to the board from every state which has issued the applicant a license or other authorization to practice medicine stating:

      1. a. Whether the license or other authorization is or was, during its period of validity, in good standing; and
      2. b. Whether any disciplinary action was taken against the license or other authorization to practice;
   3. (3) Documentation that the applicant has passed an initial examination administered by the NCCPA;
   4. (4) A copy of the applicant’s curriculum vitae or resume shall accompany the application; and

   5. (5) Two letters of reference one provided by a physician, and one provided by either a physician or physician assistant, who have served in an advisory capacity, containing the statement that the physician(s) or physician assistant(s) find the applicant to be a person of high moral character worthy of being granted a license to practice in New Hampshire. The letter shall contain the following information:

      1. a. The physician’s or physician assistant’s name, address, and telephone number;
      2. b. The name of the applicant;
      3. c. The relationship between the applicant and the person providing the reference; and
      4. d. The number of years the applicant has known the person providing the reference.
5. (e) The application shall be processed, and an approval or a denial issued in accordance with Plc 304.06 through Plc 304.13.

Source. #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96 New. #6472, eff 3-25-97, EXPIRED: 3-25-05 New. #8678, eff 7-11-06; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 600); ss by #12972, eff 1-10-20; ss by #13249, eff 8-6-21; ss by #13803, eff 12-31-23 (see Revision Note #2 at chapter heading for Med 600)