(a) Original documents may include, but are not limited
to, those listed in subsections (b) and (c) of this section.
(b) Documentation required of all applicants for licensure.
(1) evidence of relevant work experience, including
a description of the applicant's responsibilities and of the duties
that were performed;
(2) Transcripts of courses taken and grades obtained
from a college or university granting the applicant's degree and if
required under these rules, a certificate of completion of training
to demonstrate compliance with educational requirements of this chapter.
If a college or university does not issue an official transcript,
the board may accept another form of official documentation or sworn
evidence of the degree or successful completion of courses.
(3) a statement of the medical physics specialty for
which the application is submitted;
(4) three current professional references as follows:
(A) two medical physicists. If the applicant is applying
for one specialty, both physicists must be practicing in that specialty
area. If the applicant is applying for two or more specialties, one
physicist must be practicing in one of those specialties and the other
physicist must be practicing in another one of the specialties for
which the applicant is making application;
(B) one licensed physician practicing in at least one
of the specialties for which the applicant is making application;
however, if the applicant is applying for a license in the specialty
area of medical health physics, the physician may be practicing in
diagnostic radiology, radiation oncology, or nuclear medicine;
(C) if applying for a training license, post-secondary
academic references may be substituted.
(5) Birth Certificate/Proof of Age. Each applicant
for licensure must provide a copy of a birth certificate and translation,
if necessary, to prove that the applicant is at least 21 years of
age. In instances where a birth certificate is not available the applicant
must provide copies of a passport or other suitable alternate documentation.
(6) Name change. Any applicant who submits documentation
showing a name other than the name under which the applicant has applied
must present copies of marriage licenses, divorce decrees, or court
orders stating the name change. In cases where the applicant's name
has been changed by naturalization, the applicant should send the
original naturalization certificate by certified mail to the board
office for inspection.
(7) Examination verification. Each applicant for licensure
must have the appropriate testing service(s) or testing boards, that
administered the medical physicist specialty examination(s) required
under this chapter, submit verification of the applicant's passage
of the examination directly to the board.
(8) Training license affidavit. Each applicant must
submit a completed form, furnished by the board, titled "Training
license Affidavit" prior to the issuance of a training license.
(9) License verifications. Each applicant for licensure
who is licensed, registered, or certified in another state must submit
a copy of the license, registration or certificate issued by the relevant
state board.
(10) Criminal History record information.
(A) Each applicant for a license must submit a complete
and legible set of fingerprints, on a form prescribed by the Board,
to medical board or to the Department of Public Safety for the purpose
of obtaining criminal history record information from the Department
of Public Safety and the Federal Bureau of Investigation.
(B) the Board shall conduct a criminal history check
of each applicant for a license using information:
(i) provided by the applicant for license under this
subsection;
(ii) made available to the Board by the Department
of Public Safety, the Federal Bureau of Investigation, and any other
criminal justice agency under Chapter 411, Government Code.
(11) National Practitioner Data Bank/Health Integrity
and Protection Data Bank (NPDB-HIPDB). Each applicant must contact
the NPDB-HIPDB and have a report of action submitted directly to the
board on the applicant's behalf.
(c) Applicants may be required to submit other documentation,
which may include the following:
(1) Translations. Any document that is in a language
other than the English language will need to have a certified translation
prepared and a copy of the translation submitted with the translated
document.
(A) An official translation from the school or appropriate
agency attached to the foreign language transcript or other document
is acceptable.
(B) If a foreign document is received without a translation,
the board will send the applicant a copy of the document to be translated
and returned to the board.
(C) Documents must be translated by a translation agency
who is a member of the American Translation Association or a United
States college or university official.
(D) The translation must be on the translator's letterhead,
and the translator must verify that it is a "true word for word translation"
to the best of his/her knowledge, and that he/she is fluent in the
language translated, and is qualified to translate the document.
(E) The translation must be signed in the presence
of a notary public and then notarized. The translator's name must
be printed below his/her signature. The notary public must use the
phrase: "Subscribed and Sworn this _______ day of ________, 20___."
The notary must then sign and date the translation, and affix his/her
notary seal to the document.
(2) Arrest records. If an applicant has ever been arrested
the applicant must request that the arresting authority submit to
the board copies of the arrest and arrest disposition.
(3) Inpatient treatment for alcohol/substance disorder
or mental illness. Each applicant that has been admitted to an inpatient
facility within the last five years for treatment of alcohol/substance
disorder or mental illness must submit the following:
(A) applicant's statement explaining the circumstances
of the inpatient treatment/hospitalization;
(B) all records, submitted directly from the inpatient
facility;
(C) a statement from the applicant's treating physician/psychotherapist
as to diagnosis, prognosis, medications prescribed, and follow-up
treatment recommended; and
(D) a copy of any contracts signed with any licensing
authority, professional society or impaired practitioner committee.
(4) Outpatient treatment for alcohol/substance disorder
or mental illness. Each applicant that has been treated on an outpatient
basis within the past five years for alcohol/substance disorder must
submit the following:
(A) applicant's statement explaining the circumstances
of the outpatient treatment;
(B) a statement from the applicant's treating physician/psychotherapist
as to diagnosis, prognosis, medications prescribed, and follow-up
treatment recommended; and
(C) a copy of any contracts signed with any licensing
authority, professional society or impaired practitioners committee.
(5) Additional documentation. Any additional documentation
required to facilitate the investigation of an application for licensure
may be required of the applicant.
(d) The board may, in unusual circumstances, allow
substitute documents where the applicant demonstrates exhaustive efforts
to secure the required documents. These exceptions are reviewed by
the board's executive director on a case-by-case basis.
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