Only $35.99/year

Terms in this set (149)

Original dated letter addressed to the board and signed by the petitioner
--How petitioner has been affected by loss of license
--Why favorable action by the board is warranted
-Plans to resume pharmacy practice or employment and the actions the petitioner will take to ensure compliance with all laws and regs
--Professional and personal activities from the date of loss of license to present

Documentation outlining successful completion of specific conditions (if applicable)

Written verification from licensing agency in another jurisdiction documenting conditions for reinstatement have been met (if applicable)

Statement identifying any occupational or professional licenses or credentials
--license number
--verification of current license status by licensing entity
--listing of any resolved or pending complains including disciplines

Original report from NPDB

Resume or CV that identifies at a minimum the petitioners employment and other actives from the date of loss of license to present

Official docs of any completed educational programs or academic degrees since loss of license

Docs of any completed professional CE since loss of license

Official notarized statements from at least 3 individuals, one of whom must be a pharmacist whose license is current and in good standing without conditions
--acknowledge having read the consent agreement or final decision and order relating two the petitioners loss of license
--Have current relationship with petitioner
--Recommend reinstatement with supporting reasons

Completed license reinstatement questionnaire

Completed criminal offender record information (CORI)