Public Information Center Professionals Credentialing Help Desk Directory Data Portal   Site Map
Definitions Downloads FAQ Help Request Services  
All the downloadable documents below require Adobe Acrobat Reader to view.
 

Rules and Regulations


Arkansas Medical Practices Acts & Regulations
Access to Medical Records - Arkansas Code Annotated 16-46-106
Regulation 30 (Collaborative Practice Regulation)



CCVS Related Forms


Authorization and Release          CCVS Attestation          CCVS User's Manual
                                   
Policies and Procedures                  Roster Example                   



Back to top
Licensing Forms


Licensing Applications
Medical Doctors / Osteopathic Doctors Respiratory Therapists Occupational Therapist /
Occupational Therapist Assistant
 
Medical Corporations Physician Assistants Radiologist Assistant /
Radiology Practitioner Assistant
 

Physician
Application Instructions   Authorization and Release   CCVS Information   Cover Letter
Licensure Requirements   Guide to Requesting Online Verifications   MPA Notice   Physician's Health Committee Authorization and Release  
Professional Liability Verification   Rules and Regulations Affidavit   Verification of Clinical Clerkship   Verification of Hospital/Clinic Affiliation
Verification of License   Verification of Medical Education   Verification of Employment (Non-Medical or Teaching)   Verification of Military Service
Verification of Post Graduate Training   Verification of Specialty Board        

ASMB Disapproved  Schools List


Physician Assistant
Authorization and Release   Back Up Rules and Regulation Affidavit   Back Up Supervisor Physician Application    
Cover Letter   Backup Supervising Physician Scope of Practice Statement   MPA Notice    
PA Protocol Example   Professional Liability Verification   Rules and Regulations Affidavit   Supervising Physician Application  
Supervising Physician Rules and Regulation Affidavit   Verification of Education   Verification of Hospital/Clinic Affiliation   Verification of Licensure  
Verification of Undergraduate Education   NCCPA Eligibility / Exam Request        


Respiratory Care
Cover Letter   Disciplinary Action Verification   Rules and Regulations   Rules and Regulations Affidavit
Verification of Education   Verification of Hospital/Clinic Affiliation   Verification of License


Occupational Therapy
Cover Letter   Requirements   Rules and Regulations   Rules and Regulations Affidavit
Verification of Education   Verification of Hospital/Clinic Affiliation   Verification of License


Radiologist Assistant

Radiologist Assistant Practice Specific Document


Miscellaneous

  Change of Address Form           Authorization to Release Pending Licensure Application File Information



Back to top
Regulatory Forms


Dispensing Application   Exemption of Regulation 7 Application   Exemption of Regulation 17 Application  
Malpractice Reporting Form  



Back to top
Miscellaneous Forms


ASMB Fee Schedule                  Change of Administrator Form          Change of Address Form



Back to top
Program Downloads


All the downloadable documents below require Adobe Acrobat Reader to view.
 



Back to top