052-1 Wyo. Code R. §§ 1-15 - Interstate Medical Licensure Compact
(a)
Letter of Qualification. In determining whether a physician licensed by the
board is eligible to receive a letter of qualification from the board for
licensure in other states through the Interstate Medical Licensure Compact the
following criteria will be used:
(i) To
determine whether the physician may use Wyoming as his state of principal
license, the physician must demonstrate that Wyoming one or more of the
following for him or her:
(A) State of
principal residence. The address of the principal residence must be a structure
at a physical location in the state of Wyoming. Postal service and private mail
boxes are not acceptable. For residences not titled in the name of the
applicant, the applicant may be asked to provide a current lease or rental
agreement, or utility bill for that address, with the applicant's name on
it.
(B) State where at least 25% of
the physician's practice of medicine occurs.
(C) State where the physician's employer is
located. Location of a physician's employer may demonstrated by a copy of the
physician's employment contract or agreement with the employer, or a copy of a
pay stub
(D) State designated as
state of residence for federal income tax purposes. The physician may be
required to produce a copy of his or her most recent federal income tax
return.
(ii) In the
event a physician is found to not be eligible for a letter of qualification
from the Wyoming Board of Medicine, the physician may request that
determination be reviewed by the Application Review Committee. The Application
Review Committee's decision that the physician is not eligible to receive a
letter of qualification from the Wyoming Board of Medicine to participate in
the Interstate Medical Licensure Compact may be appealed to the full
board.
(b) Issuance of
licenses as a Member Board. An applicant for a Wyoming physician license issued
by the board through the Interstate Medical Licensure Compact shall, within
thirty (30) days of issuance of the license, and as a condition of continuing
to hold the license, complete and submit to the board office an information
form. The form shall include, but is not limited to, licensee address and
contact information. Failure to complete and return the renewal information
form will constitute a violation of this provision, and may result in
disciplinary action pursuant to W.S. 33-26-402(a)(x) or (xxxi), or other
applicable provisions of the act.
(c) Licensees renewing a Wyoming physician
license issued by the board through the Interstate Medical Licensure Compact
shall, as a condition of renewing the license, complete and submit to the board
office a renewal information form. The form shall include, but is not limited
to, licensee address and contact information updates, and attestation questions
regarding their activities since the latter of the original issuance of the
license or its most recent renewal. The renewal information form shall be
completed and returned to the board office within thirty (30) days of the
issuance of the renewed license by the board. Failure to complete and return
the renewal information form will constitute a violation of this provision, and
may result in disciplinary action pursuant to W.S. 33-26-402(a)(x) or (xxxi),
or other applicable provisions of the act.
(d) Revocation or rescission of a Letter of
Qualification used to obtain a Wyoming physician license.
(i) If the Letter of Qualification used by a
physician to obtain a Wyoming physician license through the Interstate Medical
Licensure Compact is revoked, rescinded or otherwise terminated by the issuing
state medical board for any reason other than expiration of the Letter of
Qualification, the physician shall submit the following additional information
to the Board:
(A) A completed supplemental
information form;
(B) A current
F.C.V.S. packet;
(C) Three (3)
completed physician reference questionnaire forms from physicians with whom the
applicant has practiced medicine within the past three (3) years. References
from physicians with whom the applicant has a current or prospective financial,
business or family relationship are not acceptable;
(D) An affidavit and authorization for
release of information on a form provided by the Board; and,
(E) Pursuant to 8 U.S.C. 1621, a Citizenship
and Alien Status Verification form approved or prescribed by the
board.
(ii) The
additional information shall be submitted to the Board no later than ninety
(90) days after the revocation, rescission or other termination of the Letter
of Qualification. Failure to submit the additional information by this deadline
is grounds for discipline.
(iii) If
the Letter of Qualification is revoked, rescinded, or otherwise terminated
because of a misstatement, misrepresentation or omission by the physician, the
physician may also be subject to disciplinary action under W.S. 33-26-402(a)(i)
and other applicable provisions.
(e) Reactivation of license issued through
the IMLC. A licensee holding a lapsed license previously issued through the
IMLC may apply to reactivate it following the procedure set forth in Section 12
of this chapter.
(f) Renewal of
license that can no longer be renewed through the IMLC.
(i) If a physician licensed in Wyoming
through the IMLC becomes ineligible to renew the license through the IMLC
because of a failure to meet the requirements of subsection 7(a) of the Compact
(W.S. 33-26-702, Article 7(a)). the license may be renewed directly with the
Board. The physician shall complete the paper license renewal form and submit
it and the requisite fees to the Board.
(ii) In subsequent years, the license shall
be subject to renewal pursuant to Section 10 of this chapter.
Notes
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