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Document Citation:
Wis. Adm. Code Med 22.06
Header:
WISCONSIN ADMINISTRATIVE CODE
MEDICAL EXAMINING BOARD
CHAPTER MED 22 PERFUSIONISTS
Date:
02/18/2014
Document:
Med 22.06 Locum tenens license
(1) An applicant who holds certification in clinical perfusion granted by the American Board of Cardiovascular Per-fusion may apply to the board for temporary locum tenens license.
(2) An applicant for a locum tenens license shall submit to the board all of the following:
(a) A completed and verified application form supplied by the board.
(b) A letter from a physician licensed to practice medicine and surgery in this state or a perfusionist licensed to practice perfusion in this state requesting the applicant's services.
(c) Verified evidence of certification in clinical perfusion granted by the American Board of Cardiovascular Perfu-sion.
(d) A verified statement by the applicant that the applicant is familiar with the state health laws and the rules of the department of health services as related to communicable diseases.
(e) The fees required under s. 440.05, Stats., made payable to the Wisconsin department of safety and professional services.
(3) All applicants shall complete an open book examination on statutes and rules governing the practice of perfu-sion in Wisconsin.
(4) The holder of a locum tenens license may engage in the practice of perfusion only in the geographical area for which the license is issued.
(5) A locum tenens license expires 90 days from the date of its issuance. For cause shown to the satisfaction of the board, the board may renew the locum tenens license for additional periods of 90 days each, but no license may be renewed more than 3 consecutive times.
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