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Rules and Regulations


Arkansas Medical Practices Acts & Regulations
Access to Medical Records - Arkansas Code Annotated 16-46-106
Regulation 27 (Informed Consent For Gastric Bypass Surgery)


CCVS Related Forms


CCVS Renewal Example          CCVS Application Packet Example          Roster Example
Addendum 1                  Level 3 Attestation                   
Policies and Procedures                  Authorization and Release - Single Facility                   


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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   Physiciain'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        


Physician Assistant
Authorization and Release   Back Up Rules and Regulation Affidavit   Back Up Supervisor Physician Application   Controlled Substance Supervising Physician Review Form  
Cover Letter   Backup Supervising Physician Scope of Practice Statement   MPA Notice   PA Prescription Writing Report Form  
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


Miscellaneous

Application Packet Example   Change of Administrator Form   Authorization to Release Pending Licensure Application File Information


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Regulatory Forms


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


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Support Forms


Support Alert Fax Coversheet         


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Miscellaneous Forms


ASMB Fee Schedule                  Change of Administrator Form          Change of Address Form


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Program Downloads


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