N.H. Admin. Code § Mirt 403.02

Current through Register No. 50, December 12, 2024

Section Mirt 403.02 - Reinstatement Application Form

The reinstatement application form shall:

(a) Be the "Application for Reinstatement of Licensure" form, dated June 2020;

(b) Be provided by the board and available on the board's web site, https://www.oplc.nh.gov/medical-imaging/index.htm; and

(c) Be signed and dated below the following preprinted statement which asserts:

"I acknowledge that knowingly making a false statement on this application form is a misdemeanor under RSA 641:2, I. I certify that the information I have provided on all parts of the application form and in the documents that I have personally submitted to support my application is complete and accurate to the best of my knowledge and belief. I also certify that I have read the statute and rules of the Board and promise that, if I am licensed, I will abide by them.

I certify that I have not engaged in medical imaging or radiation therapy in New Hampshire on volunteer or paid basis since the date that my license ceased to be valid."

N.H. Admin. Code § Mirt 403.02

Derived from Volume XL Number 33, Filed August 13, 2020, Proposed by #13075, Effective 7/24/2020, Expires 7/24/2030.