La. Admin. Code tit. 46 § XLV-6517

Current through Register Vol. 50, No. 11, November 20, 2024

Section XLV-6517 - Original Application

A. An application for registration as a dispensing physician under this Chapter shall include:

1. the applicant's full name, home address, and the municipal and post office addresses of each office or other location at which the applicant practices medicine in the state of Louisiana;

2. the name, municipal and post office address of the medical firm or firms, if any, with which the applicant is associated, and the full names of all physician partners or employees of such firm or firms;

3. the applicant's Louisiana controlled dangerous substance license number and the applicant's United States Drug Enforcement Agency (DEA) controlled substance registration number;

4. the municipal and post office addresses and telephone number of each location at which the applicant dispenses or proposes to dispense medications;

5. a designation of the schedules, classes, types, or specific medications which the applicant dispenses or proposes to dispense;

6. certification by affidavit or other proof, documented in a form satisfactory to the board as specified by the secretary, that the applicant possess the qualifications for registration set forth by this Chapter; and

7. such other information and documentation as the board may require to evidence qualification for registration as a dispensing physician.

B. The board may refuse to consider any application which is not complete in every detail and may, in its discretion require a more detailed or complete response to any request for information set forth in the application form as a condition to consideration of an application.

C. Each original or initial application for registration as a dispensing physician shall be accompanied by a fee of $75.

La. Admin. Code tit. 46, § XLV-6517

Promulgated by the Department of Health and Human Resources, Board of Medical Examiners, LR 13:571 (October 1987).

AUTHORITY NOTE: Promulgated in accordance with R.S. 37:1261-1292 and 37:1204.