(1) A health care practitioner is eligible to apply to the division and board for a volunteer health care practitioner license if the health care practitioner:

1. (a) certifies to the division and board that the applicant will be engaged exclusively in volunteer health care services; and

2. (b) completes an application for a volunteer health care practitioner license, which includes documentation:

   1. (i) of professional education, exams passed, and graduation;
   2. (ii) of practice history;
   3. (iii) of a qualified location for which the health care practitioner will be practicing;
   4. (iv) identifying the supervising health care practitioner and the supervising health care practitioner's delegation of service agreement with the volunteer practitioner; and

   5. (v) that the applicant has:

      1. (A) previously been issued an unrestricted license to practice in Utah or another state of the United States;
      2. (B) never been the subject of any significant disciplinary action in any jurisdiction; and
      3. (C) is in good health and does not have a condition which would impair the health care practitioner's ability to practice with reasonable skill and safety to patients.

(2) A health care provider who has agreed to be a supervising professional for a volunteer at a qualified location shall:

1. (a) enter into a delegation of service agreement with the volunteer health care practitioner;
2. (b) agree to provide the level of supervision required in Subsection 58-81-102(5);
3. (c) determine with the volunteer whether the volunteer's scope of practice or ability to prescribe controlled substances will be limited by the delegation of service agreement;
4. (d) include in the delegation of service agreement that the volunteer may not prescribe a controlled substance to himself, the volunteer's family, or a staff member of the qualified location; and
5. (e) forward the delegation of service agreement to the division.