Utah medical & controlled substance license instructions Division of Occupational and Physician Licensing (DOPL) rev: 8/9/16

Transcription

1 Utah medical & controlled substance license instructions Division of Occupational and Physician Licensing (DOPL) rev: 8/9/16 Programs Exempt from the Utah controlled substance license: ALL Pathology and Pediatric Critical Care In addition to holding a Federal DEA license, the state of Utah requires any physician writing controlled substance prescriptions to also obtain a Utah controlled substance license. 1. If you are participating in a program exempt from the Utah controlled substance license, but you are moonlighting, you are required to obtain both a Utah controlled substance license and a Federal DEA (at your own expense). 2. Even if you are transferring a Federal DEA from another state, you are required to obtain a Utah controlled substance license in addition to a Utah medical license. NOTE: If you are joining an accredited program (ACGME, ABMS, ABOG & CAST), save your receipt for reimbursement. Check with your program for possible reimbursement if you are joining a program that is not accredited since the GME Office is not permitted to reimburse you. Please carefully follow the instructions and associated print screens below. They explain how to complete both the Utah medical and Utah controlled substance license applications through DOPL s online portal (these are two separate applications). Many house officers miss the steps to complete the 2 nd application for the Utah controlled substance license, which may delay your hire date. DO NOT begin this application until you receive confirmation from FCVS that your FCVS packet has been sent to DOPL. DOPL will issue an initial denial letter if you submit this application too soon. Utah medical license application: Follow Steps 1 14 Utah controlled substance license application: If applicable, follow steps 15-19

2 Step 1. After you receive confirmation from FCVS, go to Step 2: Select Register a Person

3 Step 3: You will be prompted to create a login a. Type in your Last Name, SSN, then click Search to verify no Utah medical license exists b. A message stating the site was unable to find you in their records will appear. c. You are then prompted to begin the application process.

4 Step 4: Continue Create Login a. Complete the biographic Info section i. Leave the Home State field blank (this is for nurses) b. Create a User ID and Password

5 Step 5: The next page should show that you have successfully registered, with a link to Please login a. Click on the Login link

6 Step 6: Complete the License Type Selection a. Profession: Choose either Physician (MD) or Osteopathic Physician (DO) b. License Type: Choose Physician & Surgeon c. Obtained By Method: Select Application

7 Step 7: Verify your Personal Information

8 Step 8: Enter a Mailing Address a. Your Utah medical license will be mailed to the address you provide here. It typically takes DOPL 4-6 weeks to issue the license. Provide an address where you will be for at least this long.

9 Step 9: Add the Designation of Contact Person for Access to Medical Records a. Primary Contact i. Name: Release of Information Desk ii. Address: U of U Hospital, 30 N 1900 E iii. City, State, Zip: SLC, UT iv. Phone Number: b. Alternate Contact i. Name: Alan J. Smith, PhD, MEd ii. Address: U of U Hospital, 30 N 1900 E iii. City, State, Zip: SLC, UT iv. Phone Number: c. Patients will be notified by: i. Phone: Check X ii. Mail: Select YES iii. In Person: Check X iv. Other: leave blank

10 Step 10: a. Affidavit: confirm you completed at least 24 months of ACGME accredited residency training b. Professional Licenses: list any state medical licensure (no need to list training licenses) c. Documents Requested: i. FSMB notification date: Do Not submit this application until FCVS confirms your FCVS packet has been sent to DOPL, otherwise you will receive an initial denial letter from DOPL stating they will not proceed with your application without the FCVS packet. ii. Date License Verification was requested: Leave this field blank, DOPL will request verifications of any other state licenses. DOPL will contact you if for some reason they are not able to obtain verification from a given state.

11 Step 11: Qualifying Questions (there are 29 questions) a. Answer honestly, it is better to be forthcoming at this stage of the application. DOPL will only use what is necessary when determining your eligibility for licensure. b. Contact the GME Office if you are concerned about answering or have questions about answering any of these questions. Question 1. Have you ever had a license, certificate, permit, or registration to practice a regulated profession denied, conditioned, curtailed, limited, restricted, suspended, revoked, reprimanded, or disciplined in any way? Answer Please Choose 2. Have you ever been permitted to resign or surrender your license, certificate, permit, or registration to practice in a regulated profession while under investigation or while action was pending against you by any professional licensing agency or criminal or administrative jurisdiction? 3. Are you currently under investigation or is any disciplinary action pending against you now by any local, state or federal licensing, enforcement or regulatory agency? 4. Have you ever been declared by any court to be incompetent by reason of mental defect or disease and not restored? 5. Have you ever had a documented case in which you were involved as the abuser in any incident of verbal, physical, mental or sexual abuse? 6. Have you been terminated, suspended, reprimanded, sanctioned, or asked to leave voluntarily from a position 7. Are you currently using or have you recently (within 90 days)used any drugs (including recreational drugs) without a valid prescription, the possession or distribution of which is unlawful under applicable state or federal laws? Please Choose Please Choose Please Choose Please Choose Please Choose Please Choose NOTE: Charges that were later dismissed and motor vehicle offenses such as driving while impaired or intoxicated must be disclosed; however, minor traffic offenses such as parking or speeding violations need not be listed. If you answered Yes to any of the above questions, attach complete information with respect to all circumstances and the final result, if such has been reached. If you answered Yes to Questions 9, 10, 11, or 12 you must attach the following for EACH and EVERY incident (on the next page): Personal account of the incident police report(s) court record(s) probation/parole officer report(s) If you answered "YES" to question 28 you must submit a complete narrative of the circumstances and a National Practitioner Data Bank report outlining all professional liability claims made against your license and any settlements paid by or on your behalf. If you are unable to obtain any of the records required above, you must submit documentation on official letterhead from the police department and/or court indicating that the information is no longer available. 1. changes relating to my license/certification/registration.

12 Step 12: Document Upload a. Upload the DOPL Signed Release from the GME website b. Upload any documentation here if you answered yes to any qualifying questions

13 Step 13: Review the Application Summary page for any errors

14 Step 14: If you are only applying for a Utah medical license, this is the last step a. Add the license application to your cart, check out, and pay the fee (currently $200) Print/PDF the following screen: It is your DOPL Receipt. You can t access this screen later!

15 Reminder: These next set of instructions do not apply to Pathology programs nor Pediatric Critical Care (unless you plan to moonlight). Step 15: Applying for Utah controlled substance license a. Go back to the Licensing Home Page to apply for a new license

16 Step 16: License Type Selection a. Profession: Choose either Physician (MD) or Osteopathic Physician (DO) b. License Type: Physician/Surgeon CS c. Secondary Type: Schedule 2-5 d. Obtained By Method: Application

17 Step 17: Qualifying Questions (if your answers do not pre-populate, you must answer all 29 again)

18 Step 18: Document Upload a. You should have already uploaded your documents as part of the medical license application

19 Step 19: This is the last step to submit the Utah medical and Utah controlled substance license applications a. Add the controlled substance application to your cart, check out, and pay the fee b. Utah medical license: currently $200; Utah controlled substance: currently $100 Print/PDF the following screen: It is your DOPL Receipt. You can t access this screen later!