21 NCAC 52 .0611             FORMS AND APPLICATIONS

(a)  The Board shall issue the following items in accordance with applicable state statutes and this Chapter's administrative rules:

(1)           Certificate of Licensure;

(2)           Licensure Renewal Card;

(3)           Temporary License Certificate; and

(4)           Certificate of Corporate Registration.

(b)  The Board shall provide and require use of the following application forms that may be obtained from the Board's web site, http://www.ncbpe.org:

(1)           Licensure Renewal Application;

(2)           Disclaimer Form;

(3)           Corporate Registration Application;

(4)           Corporate Registration Renewal;

(5)           Specialty Credentialing Application;

(6)           CME (Continuing Medical Education) Submission Form;

(7)           Recommendation Form; and

(8)           License Application (Regular, Temporary, Military, Reciprocity).

History Note:        Authority G.S. 55B-10; 55B-11; 90‑202.4(g); 90-202.6; 90-202.7; 90-202.9; 90-20.10; 90-202.11;

Eff. June 1, 2011;

Amended Eff. October 1, 2014;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 28, 2014;

Amended Eff. November 1, 2015.