1. (1) complete the division approved form for the delegation of service agreement; and

2. (2) sign the affidavits in the application certifying that:

   1. (a) the applicant understands the applicable laws and rules;
   2. (b) the applicant will engage exclusively in volunteer health care services;
   3. (c) the applicant will not receive compensation for services; and
   4. (d) an agreement for delegation of services is in place.

In accordance with Subsections 58-1-203(1)(g) and 58-1-301(3), the application requirements for licensure in Section 58-81-104 are established as follows. The applicant shall:

KEY: licensing, volunteer health care practitioner

Date of Last Change: June 22, 2009

Notice of Continuation: November 6, 2023

Authorizing, and Implemented or Interpreted Law: 58-1-106(1)(a); 58-81-104(4)