Chapter 4731-6 Medical or Osteopathic License

4731-6-01 Definitions.

As used in Chapter 4731-6 of the Administrative Code, the following definitions are applicable:

(A) "ACGME" means the accreditation council for graduate medical education.

(B) "AMA" means the American medical association.

(C) "AOA" means the American osteopathic association.

(D) "Board" means the state medical board of Ohio.

(E) "Combined post-graduate training program" means a training program in which two recognized specialties, each of which is separately accredited at the sponsoring institution, are combined into a single program, leading to eligibility for specialty board certification in both specialties.

(F) "COMLEX-USA" means the as prepared by the national board of osteopathic medical examiners.

(G) "COMVEX-USA" means comprehensive osteopathic medical variable purpose examination.

(H) "ECFMG" means the educational commission for foreign medical graduates.

(I) "FCVS" means the federation credentials verification service, a permanent, central repository of documents verifying licensure applicants' core credentials.

(J) "Federation" means the federation of state medical boards of the United States, Inc." (K) "FLEX" means the federation licensing examination as prepared by the federation.

(L) "LCME" means the liaison committee on medical education.

(M) "LMCC" means licentiate of the medical council of Canada.

(N) "Medical and osteopathic examination" means the examination conducted under section 4731.13 of the Revised Code.

(O) "Resident," "intern" or "clinical fellow" means any individual participating at any level in graduate medical education as defined in divisions (A)(1)(a) and (A)(1)(b) of section 4731.091 of the Revised Code, including individuals serving as house officers, house staff, trainees, fellows and junior faculty who are participating in such graduate medical education.

(P) "SPEX" means the special purpose examination as prepared by the federation.

(Q) "TSE" means the test of spoken English of the educational testing service.

(R) "USMLE" means the Unites States medical licensing examination as prepared by the federation and the national board of medical examiners in a joint program.

Eff 2-29-88 (Emer.); 6-6-88; (Emer.); 11-1-88 (Emer.); 12-19-88; 2-10-89; 8-15-93; 3-27-97; 12-1-99; 10-31-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4731.05
Rule amplifies: RC 4731.091 , 4731.12 , 4731.13 , 4731.142 , 4731.291 , 4731.292 , 4731.293 , 4731.294
R.C. 119.032 review dates: 07/30/2004 and 10/31/2009

4731-6-02 Preliminary education for medical and osteopathic licensure.

(A) Production of a diploma from a medical or osteopathic medical school that, at the time the diploma was issued, was a medical school accredited by the LCME or an osteopathic medical school accredited by the AOA constitutes prima facie evidence that the individual has completed the requisite preliminary education under section 4731.09 of the Revised Code.

(B) Production of an ECFMG certificate constitutes prima facie evidence that the individual has completed the requisite preliminary education under section 4731.09 of the Revised Code.

(C) Sixty semester hours or its equivalent shall be considered two years of under-graduate work as required by section 4731.09 of the Revised Code.

R.C. 119.032 review dates: 07/29/2004 and 07/29/2009

Promulgated Under: 119.03

Statutory Authority: 4731.05

Rule Amplifies: 4731.09 , 4731.091 , 4731.12 , 4731.13 , 4731.142 , 4731.291 , 4731.292 , 4731.293 , 4731.294

Prior Effective Dates: 2/10/82, 2/29/88 (Emer.), 6/6/88 (Emer.), 11/1/88, 12/19/88, 2/10/93, 8/15/93, 12/1/99

4731-6-03 Eligibility for the medical and osteopathic examination.

(A) An applicant for consideration to take the medical and osteopathic examination must satisfy the requisite preliminary education pursuant to section 4731.09 of the Revised Code and must meet the educational requirements of section 4731.09 1 of the Revised Code.

(B) An applicant must have successfully completed one of the following:

(1) Step 1 and step 2 of the USMLE; or

(2) Level 1 and level 2 of the COMLEX-USA.

(C) Successful completion of step 1 or step 2 of the USMLE means attaining that figure established by the USMLE program as a passing performance for that step.

(D) Successful completion of level 1 and level 2 of the COMLEX-USA means attaining that figure established by the NBOME as a passing performance for that level.

Eff 2-29-88 (Emer.); 6-6-88 (Emer.); 11-1-88; 12-19-88; 2-10-89; 8-15-93; 12-1-99; 10-31-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4731.05
Rule amplifies: RC 4731.08 , 4731.09 , 4731.091 , 4731.12 , 4731.13 , 4731.142 , 4731.291 , 4731.292 , 4731.293 , 4731.294
R.C. 119.032 review dates: 07/30/2004 and 10/31/2009

4731-6-04 Demonstration of proficiency in spoken English.

Demonstration of proficiency in spoken English, pursuant to section 4731.142 of the Revised Code, requires successful completion of the "Test of English as a Foreign Language, Internet-based Test" ("TOEFL iBT"). Successful completion of the TOEFL iBT requires a total score of ninety or higher and the following minimum scores or higher by section:

(A) Writing: no minimum;

(B) Speaking: twenty-six;

(C) Listening: twenty-six; and

(D) Reading: no minimum.

Effective: 02/28/2008
R.C. 119.032 review dates: 02/28/2013
Promulgated Under: 119.03
Statutory Authority: 4731.05
Rule Amplifies: 4731.142

4731-6-05 Format of medical and osteopathic examination.

The medical and osteopathic examinations shall be the USMLE step 3 or the COMLEX-USA level 3. Applicants for the USMLE step 3 or for the COMLEX-USA level 3 examination will not be required to submit an application to the board or to demonstrate to the board that they meet the requirements of section 4731.08 , 4731.09 , 4731.091 or 4731.11 of the Revised Code in order to gain admission to the examination. Application will be made directly to the USMLE program or to the COMLEX-USA program.

Eff 2-29-88 (Emer.); 6-6-88 (Emer.); 8-15-93; 12-1-99; 10-31-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4731.05
Rule amplifies: 4731.08 , 4731.09 , 4731.091 , 4731.11 , 4731.12 , 4731.13 , 4731.142 , 4731.291 , 4731.292 , 4731.293 , 4731.294
R.C. 119.032 review dates: 07/30/2004 and 10/31/2009

4731-6-07 Passing average on examination.

(A) The passing performance for the USMLE step 3 as reported by the USMLE program shall constitute successful completion of the examination.

(B) The passing performance for the COMLEX-USA level 3, as reported by the COMLEX-USA program shall constitute successful completion of the examination.

Eff 22-29-88 (Emer.); 6-6-88 (Emer.); 11-1-88 (Emer.); 12-19-88; 2-10-89; 8-15-93; 12-1-99; 10-31-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4731.05
Rule amplifies: RC 4731.091 , 4731.12 , 4731.13 , 4731.142 , 4731.291 , 4731.292 , 4731.293 , 4731.294
R.C. 119.032 review dates: 07/30/2004 and 10/31/2009

4731-6-10 Clinical competency examination.

For purposes of consent agreements or board orders a passing score on SPEX, as reported by the federation, or on the COMVEX-USA, as reported by the NBOME, shall constitute successful completion of the examination. Application for the SPEX will be made directly to the federation. An applicant may contact the board regarding application to the COMVEX-USA.

Eff 22-29-88 (Emer.); 6-6-88 (Emer.); 11-1-88 (Emer.); 12-19-88; 2-10-89; 8-15-93; 12-1-99; 10-31-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4731.05
Rule amplifies: RC 4731.091 , 4731.12 , 4731.13 , 4731.142 , 4731.291 , 4731.292 , 4731.293 , 4731.294
R.C. 119.032 review dates: 07/30/2004 and 10/31/2009

4731-6-14 Eligibility for licensure by examination.

(A) The board shall issue its certificate to each individual who passes the medical and osteopathic examination as provided in rules 4731-6-03 , 4731-6-05 and 4731-6-07 of the Administrative Code; who has completed the graduate medical education required by sections 4731.091 , 4731.092 and 4731.14 of the Revised Code; who demonstrates proficiency in spoken English as required by section 4731.142 of the Revised Code; and who has paid the certificate issuance fee required by section 4731.14 of the Revised Code.

(B) If the applicant passed the USMLE step 3 administered by the USMLE program or the COMLEX-USA level 3 administered by the COMLEX-USA program for Ohio, the board shall deny issuance of a certificate if it finds that the applicant does not meet the requirements of section 4731.08 , 4731.09 or 4731.091 of the Revised Code or the applicable provisions of this chapter of the Administrative Code.

(C) An applicant for a certificate to practice medicine or surgery, or osteopathic medicine and surgery who has not previously held a license from another state is eligible for consideration under section 4731.14 of the Revised Code without board examination in Ohio if the applicant otherwise meets the eligibility requirements as set forth in sections 4731.09 , 4731.091 , 4731.14 and 4731.142 of the Revised Code for licensure by board examination in Ohio and has passed one of the following examinations:

(1) One of the following examination sequences, with all steps, parts, levels or components having been administered prior to January 2000. The score achieved on each step, part, level or component must have equaled or exceeded the figure established by the USMLE program, the national board of medical examiners, the national board of osteopathic medical examiners or the federation as a passing score for that step, part, level or component, respectively.

(a) Part I of the national board of medical examiners examination or step 1 of the USMLE, part II of the national board of medical examiners examination or step 2 of the USMLE, and part III of the national board of medical examiners examination or step 3 of the USMLE or component 2 of the FLEX; or

(b) Part I of the national board of osteopathic medical examiners examination or level 1 of the COMLEX-USA, part II of the national board of osteopathic medical examiners examination or level 2 of the COMLEX-USA, and part III of the national board of osteopathic medical examiners examination or level 3 of the COMLEX-USA.

(2) Component 1 of the FLEX and step 3 of the USMLE. The component and step must have been administered prior to January 2000. A performance of seventy-five or above must have been achieved on component 1. The performance achieved on step 3 must have been recognized by the USMLE program as a recommended passing performance; or

(3) USMLE steps 1, 2 clinical knowledge, 2 clinical skills and 3 or COMLEX-USA levels 1, 2 cognitive evaluation, 2 performance evaluation and 3.

(a) An applicant shall have passed the USMLE steps 1, 2 clinical knowledge, 2 clinical skills and 3 or COMLEX-USA levels 1, 2 cognitive evaluation, 2 performance evaluation and 3 within a ten-year period, and achieved a recognized passing performance by the USMLE program on each step or step component or NBOME on each level. No applicant shall have failed any step or level more than five times.

(b) The board may grant a good cause waiver to any applicant that does not meet the requirements of paragraph (C)(3)(a) of this rule, if the applicant meets the following:

(i) Holds current specialty board certification from the American board of medical specialties or the American osteopathic association; or

(ii) Demonstrates good cause, as determined by the board, for not having passed all three steps or levels within the ten year period, and otherwise meets the requirements set forth in paragraph (C)(3)(a) of this rule.

(c) USMLE steps 1, 2 clinical knowledge, 2 clinical skills and 3 and COMLEX-USA levels 1, 2 cognitive evaluation, 2 performance evaluation and 3 cannot be combined to fulfill an acceptable testing sequence as required by paragraph (C)(3)(a) of this rule; or

(4) Component 1 and 2 of the FLEX. Both components must have been administered prior to January 2000. The score achieved on each component must have equaled or exceeded the figure established by the FLEX program as a passing score for that component.

Replaces: 4731-6-14

Effective: 10/31/2013
R.C. 119.032 review dates: 10/31/2018
Promulgated Under: 119.03
Statutory Authority: 4731.05
Rule Amplifies: 4731.08 , 4731.09 , 4731.091 , 4731.092 , 4731.12 , 4731.13 , 4731.14 , 4731.142
Prior Effective Dates: 8/15/93, 6/23/97, 12/1/99, 12/31/04, 6/30/05, 4/30/09

4731-6-15 Eligibility for licensure of national board diplomates and Medical Council of Canada licentiates.

A diplomate of the national board of medical examiners or the national board of osteopathic medical examiners or an LMCC is eligible for licensure consideration under section 4731.29 of the Revised Code without taking the Ohio medical and osteopathic examination if the applicant meets the requirements of sections 4731.09 and 4731.091 of the Revised Code, and has completed the graduate medical education required by section 4731.14 of the Revised Code for those who apply for licensure by Ohio examination.

Eff 22-29-88 (Emer.); 6-6-88 (Emer.); 11-1-88; 12-19-88; 2-10-89; 8-15-93; 12-1-99; 10-31-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4731.05
Rule amplifies: RC 4731.09 , 4731.091 , 4731.12 , 4731.13 , 4731.14 , 4731.29 , 4731.291 , 4731.292 , 4731.293 , 4731.294
R.C. 119.032 review dates: 07/30/2004 and 10/31/2009

4731-6-16 Eligibility for medical or osteopathic licensure by endorsement of licenses granted by other states.

(A) An applicant for a certificate to practice medicine or surgery, or osteopathic medicine and surgery, who holds a license from another state, is eligible for consideration without further examination under section 4731.29 of the Revised Code if the requirements of paragraphs (B) to (D) of this rule are met, and the applicant meets the eligibility requirements as set forth in sections 4731.09 , 4731.091 , 4731.14 and 4731.142 of the Revised Code for licensure by Ohio examination.

(B) The license from another state being endorsed into Ohio must be current and in good standing and must be a full and unlimited license to practice all branches of medicine or surgery, or osteopathic medicine and surgery. An exception can be made by the board in those cases where an applicant cannot renew his or her license in the other jurisdiction for purposes of endorsement due to residency or similar requirements, or in those cases where an applicant is on probation in the other jurisdiction and the board determines that it is able to impose sufficient conditions to ensure public safety.

(C) The applicant for endorsement must have passed one of the following examinations:

(1) A written state medical board of the United States licensing examination other than the FLEX, USMLE or COMLEX-USA administered prior to June 1982 without previous or subsequent FLEX, USMLE or COMLEX-USA failure; or

(2) A single three day FLEX administered prior to June 1985. The FLEX-weighted average must be seventy-five or above for the entire examination as reported by the federation, or must be seventy-two or above if the examination was taken during the first two years of a state's administration of the FLEX and such score was accepted by that state as a passing score; or

(3) Component 1 and component 2 of the FLEX administered after June 1985. A score of seventy-five or above must have been achieved on each component as reported by the federation. Both components must have been passed within a seven year period; or

(4) Part I of the national board of medical examiners examination or step 1 of the USMLE, part II of the national board of medical examiners examination or step 2 of the USMLE, and part III of the national board of medical examiners examination or step 3 of the USMLE or component 2 of the FLEX. All steps, parts or components must have been administered prior to January 2000. The score achieved on each step, part or component must have been recognized by the USMLE program, the national board of medical examiners or the federation as a passing score for that step, part or component, respectively; or

(5) Component 1 of the FLEX and step 3 of the USMLE. The component and step must have been administered prior to January 2000. A score of seventy-five or above must have been achieved on component 1. The score achieved on step 3 must have been recognized by the USMLE program as a recommended passing score; or

(6) USMLE steps 1, 2 and 3. All three steps must have been passed in accordance with paragraph (C)(3) of rule 4731-6-14 of the Administrative Code and the score achieved on each step must have been recognized by the USMLE program as a recommended passing score; or

(7) A written examination provided by the national board of osteopathic medical examiners for the administering state; or

(8) COMLEX-USA levels 1, 2 and 3. All three levels must have been passed in accordance with paragraph (C)(3) of rule 4731-6-14 of the Administrative Code and the score achieved on each level must have been recognized by the COMLEX-USA program as a recommended passing score.

(D) Notwithstanding paragraphs (A) to (C) of this rule, and in addition to grounds otherwise contained in Chapter 4731. of the Revised Code and Chapter 4731-6 of the Administrative Code, the board may refuse an applicant for endorsement who has not been engaged in any of the following activities during the two years immediately prior to the date ofapplication;

(1) The active clinical practice of medicine or surgery, or osteopathic medicine and surgery;

(2) The taking of graduate medical education as defined in section 4731.091 of the Revised Code;

(3) The attendance as a student at a medical or osteopathic school.

(E) For purposes of division (E) of section 4731.29 of the Revised Code the term "actively practicing ... in the United States" includes the taking of graduate medical education as defined in section 4731.091 of the Revised Code.

(F) An applicant will be excused from the requirement to demonstrate proficiency in spoken English under the terms of division (E)(1) of section 4731.29 of the Revised Code if the applicant's license or licenses from another state have been unrestricted and he or she was actively practicing medicine and surgery or osteopathic medicine and surgery in the United States for at least nine full months during each of the five years immediately preceding the date of his or her application. In this rule, "license" includes a training certificate or its equivalent issued to those applicants who have been actively practicing medicine and surgery or osteopathic medicine and surgery in the United States as part of graduate medical education as defined in section 4731.091 of the Revised Code.

Effective: 10/31/2013
R.C. 119.032 review dates: 07/23/2013 and 10/31/2018
Promulgated Under: 119.03
Statutory Authority: 4731.05
Rule Amplifies: 4731.09 , 4731.091 , 4731.14 , 4731.142 , 4731.29
Prior Effective Dates: 2/29/88 (Emer.), 6/6/88 (Emer.), 11/1/88 (Emer), 12/19/88, 2/10/89, 8/15/93, 12/1/99, 9/30/01, 12/31/04

4731-6-20 Requests for medical or osteopathic licensure application. [Rescinded].

Rescinded eff 10-31-04

4731-6-21 Application procedures for certificate issuance; investigation; notice of hearing rights.

(A) All applicants for medical or osteopathic licensure shall file a written application under oath on the forms prescribed by the board, and provide such other facts and materials as the board requires.

(B) All applicants must file a written application to the FCVS. All applicants for medical or osteopathic licensure shall also file a written application to the FCVS.

(C) No application shall be considered filed until the appropriate fee has been received by the board.

(D) No application shall be considered complete until the applicant has complied with the requirements of paragraph (A) of rule 4731-4-02 of the Administrative Code and the board has received the results of the criminal records checks and any other forms required to be submitted pursuant to paragraph (A) of rule 4731-4-02 of the Administrative Code.

(E) All application materials submitted to the board will be thoroughly investigated. The board will contact individuals, agencies or organizations for recommendations or other information about applicants as the board deems necessary. Applicants may be requested to appear before the board or a representative thereof as part of the application process.

(F) Any applicant to whom the board proposes to deny admission to the examination or certificate issuance pursuant to Chapter 4731. of the Revised Code or because of failure to meet any of the requirements of rules of the state medical board shall be entitled to a hearing on the issue of such proposed denial. Notice and hearing requirements incident to such proposed denial will be in compliance with the provisions of Chapter 119. of the Revised Code and any rules adopted by the board pursuant to Chapter 119. of the Revised Code.

Effective: 09/30/2008
R.C. 119.032 review dates: 10/31/2009
Promulgated Under: 119.03
Statutory Authority: 4731.05 , 4776.03
Rule Amplifies: 4731.091 , 4731.12 , 4731.13 , 4731.142 , 4731.291 , 4731.292 , 4731.293 , 4731.294 , 4776.01 , 4776.02 , 4776.03 , 4776.04
Prior Effective Dates: 2/29/88 (Emer.); 6/6/88 (Emer.); 11/1/88 (Emer.); 12/19/88; 2/10/89; 8/15/93; 12/1/99; 5/31/02; 10/31/04

4731-6-22 Abandonment and withdrawal of medical and osteopathic licensure applications.

(A) If the applicant for medical or osteopathic licensure fails to complete the application process within six months of initial application filing, the board may notify the applicant in writing of its intention to consider the application abandoned. If no response to that notice is received by the board within thirty days of mailing, the board shall consider the application as abandoned and no further processing shall be undertaken with respect to that application.

(B) If the application process extends for a period longer than six months, the board may require updated information as it deems necessary.

(C) No application for medical or osteopathic licensure may be withdrawn without approval of the board.

(D) Submitted fees shall be neither refundable nor transferable.

R.C. 119.032 review dates: 07/29/2004 and 07/29/2009

Promulgated Under: 119.03

Statutory Authority: 4731.05

Rule Amplifies: 4731.09 , 4731.091 , 4731.12 , 4731.13 , 4731.142 , 4731.291 , 4731.292 , 4731.293 , 4731.294

Prior Effective Dates: 2/10/82, 2/29/88 (Emer.), 6/6/88 (Emer.), 11/1/88, 12/19/88, 2/10/93, 8/15/93, 12/1/99

4731-6-30 Training certificates.

(A) A training certificate is mandatory for participation in an internship or residency accredited by the ACGME or the AOA, a combined post-graduate training program or a clinical fellowship program at an institution with a residency program accredited by the ACGME or the AOA in the same or a related field unless the participant holds a current certificate to practice medicine and surgery or osteopathic medicine and surgery under section 4631.14 or section 4731.29 of the Revised Code. The participation in the programs prior to receiving an acknowledgment letter from the board is the unlicensed practice of medicine pursuant to section 4731.34 of the Revised Code.

(B) A training certificate shall be issued to those applicants meeting the requirements of section 4731.291 of the Revised Code and this chapter of the Administrative Code, and who have provided evidence satisfactory to the board of being at least eighteen years of age and having a diploma from an LCME or AOA accredited medical school or an ECFMG certificate or a fifth pathway certificate. The applicant shall identify the training program to which the applicant has been appointed and the effective dates of that appointment. In addition, those applicants who are training as clinical fellows will be eligible to receive a training certificate in sub-specialty areas only if the institution in which they are pursuing a clinical fellowship has a residency program in the same or related clinical field and that residency program is accredited by the ACGME or AOA.

(C) The holder of a training certificate must limit his or her activities to those set forth in section 4731.291 of the Revised Code. The acknowledgment letter and subsequent training certificate entitle the holder to perform only such acts as may be prescribed by or incidental to the internship, residency, or clinical fellowship program, but do not entitle one to otherwise engage in the practice of medicine and surgery or osteopathic medicine and surgery in this state. The holder must train only under the supervision of the physicians responsible for supervision as part of the internship, residency or clinical fellowship program. Further, the holder must limit activities under the acknowledgment letter or training certificate to the programs of the hospital or facilities for which the training certificate is issued. Such activities may include rotations at additional sites that have affiliation agreements with the program.

(D) A training certificate may be renewed annually for a maximum of six years.

(E) The board may take disciplinary action against an applicant or holder of a training certificate upon proof, satisfactory to the board, that the holder has engaged in practice in this state outside the scope of the internship, residency or clinical fellowship program for which the training certificate has been issued, or upon other proof, satisfactory to the Board, that the applicant has engaged in conduct that is grounds for action under section 4731.22 of the Revised Code. In accordance with section 3719.121 or section 4731.22 of the Revised Code, the board may suspend, without a prior hearing, a training certificate or the right to participate in training under an acknowledgment letter issued pursuant to this rule.

(G)(F) Upon the board's receipt of an application for a training certificate, or upon the board's receipt of written notice from an applicant for a certificate to practice medicine and surgery or osteopathic medicine and surgery under section 4731.14 or section 4731.29 of the Revised Code, that the applicant intends to participate in a training program described in paragraph (A) of this rule, and after verifying that the applicant has paid the appropriate fee, the board will issue to the applicant an acknowledgment letter. Fees are neither refundable nor transferable. Upon receipt of that acknowledgment letter, the applicant may begin participating in the program that meets the requirements of section 4731.29 1 of the Revised Code, and this chapter of the Administrative Code, to which he or she has been appointed while the application is being processed. That acknowledgment letter will serve as proof that the board has received the application and that the applicant is entitled to continue participation in the training program. If an applicant has not received an acknowledgment letter from the board within forty-five days of submitting an application, then the applicant shall immediately inform the board and the director of his or her training program in writing.

(H)(G) An acknowledgment letter issued under this rule shall authorize participation in a training program for one hundred twenty days, unless prior to that time the board:

(1) Issues the certificate; or

(2) Issues an order in accordance with Ohio law suspending without a prior hearing the authority to participate; or

(3) Accepts a withdrawal of the application; or

(4) Issues a notice of opportunity for hearing in accordance with Chapter 119. of the Revised Code, in which case the authority to participate shall continue until the board's issuance of a final order granting or denying the application, or until the end of the training year, whichever comes first; or

(5) In the case of an applicant for a certificate under section 4731.14 or section 4731.29 of the Revised Code, advises the applicant in writing that a substantial question of a violation of this chapter or the rules adopted under it exists and that investigation is continuing, in which case the authority to participate shall continue until one of the following occur:

(a) The board issues a certificate; or

(b) The board issues a final order in accordance with Chapter 119. of the Revised Code; or

(c) The training year ends. Except as provided above, participation in a training program pursuant to an acknowledgment letter cannot be renewed or extended beyond one hundred and twenty days.

(H) If at the end of one hundred and twenty days following issuance of an acknowledgment letter to an applicant for a training certificate the board has commenced but not yet concluded investigation or inquiry into issues of possible violations of Chapter 4731. of the Revised Code, it shall issue a training certificate to the applicant but shall not be deemed to have waived any issues which would constitute grounds to impose discipline under Chapter 4731. of the Revised Code.

(I) If the applicant or training certificate holder changes training programs before the end of the training year while maintaining the same finishing date of his or her post graduate training year (e.g., June thirtieth), the board must be notified in writing immediately. A new application need not be completed. However, acknowledgment by the board of receipt of written notification of change in training Programs programs will be required prior to starting the new training program. The new training certificate will only be valid for the remainder of the training year for which the applicant has been issued a current certificate.

(J) A training certificate shall be valid for one training year, but may, at the discretion of the board, be renewed annually five times for a maximum of five six years. Renewal applications are mailed approximately April first for those who initiated their training on July first. Interns, residents or clinical fellows who began their training after July first of the training year will be mailed their renewal application approximately three months prior to the expiration of their training certificate.

(K) This rule and section 4731.291 of the Revised Code do not apply to or prohibit any graduate of a podiatric school or college from performing those acts that may be prescribed by or incidental to participation in an accredited podiatric internship, residency, or fellowship program accredited by the council on podiatric medical education of the American podiatric medical association.

(L) A person who holds a suspended certificate to practice medicine and surgery or osteopathic medicine and surgery under section 4731.14 or section 4731.29 of the Revised Code is not eligible for a training certificate. Such a person must restore that certificate in accordance with sections 4731.222 and 4731.281 of the Revised Code before beginning postgraduate training in Ohio. A person whose certificate has been permanently revoked or permanently denied is ineligible to participate in postgraduate training in Ohio.

Eff 2-29-88 (Emer.); 6-6-88 (Emer.); 11-1-88 (Emer.); 12-19-88; 2-10-89; 8-15-93; 12-1-99; 5-5-00 (Emer.); 10-31-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4731.05
Rule amplifies: RC 3719.121 , 4731.091 , 4731.12 , 4731.13 , 4731.14 , 4731.142 , . 4731.17 , 4731.22 , 4731.222 , 4731.281 , 4731.29 , 4731.291 , 4731.34 , 4731.41
R.C. 119.032 review dates: 07/30/2004 and 10/31/2009

4731-6-31 Limited preexamination registration and limited certification.

(A) An applicant for a limited preexamination registration to practice in state-operated institutions under section 4731.292 of the Revised Code must be a graduate of a medical or osteopathic school or college that was reputable and in good standing in the judgment of the board at the time the diploma was issued. A school shall be considered reputable and in good standing if it is accredited by the LCME or the AOA, or if its graduates are eligible for ECFMG certification. In addition, an applicant for limited preexamination registration must:

(1) Submit an application for examination under section 4731.08 of the Revised Code acceptable to the board; and

(2) Submit the required examination and registration fee; and

(3) Submit an application for limited preexamination registration.

(4) After December 1993 an applicant must have successfully completed step 1 and step 2 of the USMLE or one of the following:

(a) Part 1 of the national board of medical examiners examination or step 1 of the USMLE, and part II of the national board of medical examiners examination or step 2 of the USMLE.

(b) Component 1 of the FLEX.

(c) Component 2 of the FLEX, if the applicant is applying to take component 1 of the FLEX during 1994.

(5) After December 1999 an applicant must have successfully completed step 1 and step 2 of the USMLE.

(6) Successful completion of part I or part II of the national board of medical examiners means attaining or exceeding that figure established by the national board of medical examiners as a passing score for that part.

(7) Successful completion of step 1 or step 2 of the USMLE means the score achieved for that step must have been reported by the USMLE program as a passing score.

(8) Successful completion of component I of the FLEX means attaining a score of seventy-five or above as reported by the federation.

(B) Limited preexamination registration shall permit practice of medicine or surgery or osteopathic medicine and surgery only in the state institution for which the registration is issued and only under the supervision of the medical staff of that institution. The preexamination registration shall be valid only until such time as the applicant takes and receives the results from the licensure examination specified by rule 4731-6-05 of the Administrative Code. That examination must be taken at the applicant's first reasonable opportunity. "First reasonable opportunity" shall mean the first examination for which the applicant is scheduled by the board. The applicant shall be allowed to take two consecutive examinations before his registration expires. A choice to defer the first examination for which the applicant is scheduled by the board will be permitted, but will be counted as one of the two consecutive examinations.

(C) If the holder of a preexamination registration passes the examination administered under paragraph (B) of this rule, he or she shall be granted a limited certificate under section 4731.292 of the Revised Code upon submitting an application for a limited certificate and furnishing proof satisfactory to the board that:

(1) The applicant has filed an application for naturalization and that such application has not been rejected or withdrawn, or if not yet eligible to file an application for naturalization, the applicant has filed a declaration of intention to become a citizen of the United States in an appropriate court of record; and

(2) The applicant has successfully passed the ECFMG test; and

(3) The applicant is at least eighteen years of age and of good moral character; and

(4) The applicant will limit his or her practice and training within the physical confines of the institution for which the limited certificate to practice is granted; and

(5) The medical staff of the institution for which the limited certificate to practice is granted has approved in writing his or her application for such certificate; and

(6) The applicant will practice medicine or surgery or osteopathic medicine and surgery only under the supervision of the attending medical staff of the institution for which the limited certificate is granted.

(D) A holder of a limited certificate, upon completion of requisite training and upon receipt of his United States citizenship, shall be entitled to receive an unlimited certificate to practice. "Requisite training" shall be defined to mean that the holder of a limited certificate has completed a total of two years of training, which shall include:

(1) Training at an institution or institutions under a preexamination registration or registrations; or

(2) Training at an institution or institutions under a limited certificate or certificates; or

(3) Training in an approved internship, residency or fellowship as defined in section 4731.091 of the Revised Code.

(E) A limited certificate shall be valid for a period of one year, but can be renewed annually not more than four times. The applicant for renewal shall:

(1) Submit a renewal application containing such information as required by the board; and

(2) Submit evidence of written approval of the medical staff of the institution for which the certificate is issued; and

(3) Submit the required renewal fee.

(F) In the case of Mexican diplomas, only the titulo or the acta, along with appropriate evidence of nonconcurrent internship and social service, is considered equivalent to the degree of doctor of medicine.

(G) Chapter 4731-5 of the Administrative Code and rules 4731-6-02 , 4731-6-07 , 4731-6-21 and 4731-6-22 of the Administrative Code shall apply to applicants for limited certificates under section 4731.292 of the Revised Code.

Eff 2-29-88 (Emer.); 6-6-88 (Emer.); 11-1-88; 12-19-88; 2-10-89; 8-15-93; 12-1-99; 10-31-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4731.05
Rule amplifies: RC 4731.08 , 4731.091 , 4731.12 , 4731.13 , 4731.142 , 4731.291 , 4731.292 , 4731.293 , 4731.294
R.C. 119.032 review dates: 07/30/2004 and 10/31/2009

4731-6-32 Visiting faculty certificates.

(A) A visiting faculty certificate may be issued to an applicant holding a current, unrestricted license to practice medicine and surgery in another state or country if the applicant has been appointed to serve in this state on academic staff of an LCME or AOA accredited school and meets the eligibility requirements of section 4731.293 of the Revised Code. A current, unrestricted license is a license or other authority granted by the appropriate entity or governmental body which lawfully permits the applicant to practice all branches of medicine and surgery or osteopathic medicine and surgery without governmental restriction or limitation.

(B) The holder of a visiting faculty certificate may practice only as is incidental to teaching duties at the school, or at those teaching hospitals affiliated with the school. Those duties must be set forth upon the application and approved by the board.

(C) By signing the application for a visiting faculty certificate, the dean of the school and the medical director of each affiliated teaching hospital are responsible for assuring that the holder of the certificate does not engage in practice outside its scope. They are further responsible for reporting any belief that practice outside its scope has occurred.

(D) An individual may be granted only one visiting faculty certificate and is ineligible to apply for its renewal or a second visiting faculty certificate.

Eff 8-15-93; 10-31-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4731.05
Rule amplifies: RC 4731.091 , 4731.12 , 4731.13 , 4731.14 , 4731.142 , 4731.293
R.C. 119.032 review dates: 07/30/2004 and 10/31/2009

4731-6-33 Special activity certificates.

(A) A special activity certificate may be issued to an applicant seeking to practice medicine and surgery or osteopathic medicine and surgery in conjunction with a special activity, program, or event taking place in this state. A special activity certificate shall not be issued for purposes of locum tenens.

(B) The applicant must hold a current, unrestricted license to practice medicine and surgery or osteopathic medicine and surgery issued by another state or country and meet the educational requirements for licensure set forth in sections 4731.091 and 4731.14 of the Revised Code. A current, unrestricted license is a license or other authority granted by the appropriate entity or governmental body which lawfully permits the applicant to practice all branches of medicine and surgery or osteopathic medicine and surgery without governmental restriction or limitation.

(C) Within the two year period immediately preceding application, the applicant must have done one of the following:

(1) Actively practiced medicine and surgery or osteopathic medicine and surgery in the United States;

(2) Participated in graduate medical education accredited by the ACGME, or the AOA or a clinical fellowship program as defined in division (A)(1)(b) of section 4731.091 of the Revised Code;

(3) Passed USMLE step 3. All three steps must have been passed in accordance with rule 4731-6-14(C)(3) .

(4) Completed the COMLEX-USA sequence in accordance with rule 4731-6-14(C)(4) .

(D) The holder of a special activity certificate may practice only in conjunction with the special activity, event or program for which the certificate is issued.

(E) The determination that an applicant's practice in conjunction with the special activity, program or event will be in the public interest and that a special activity certificate can thus be issued shall be made by the secretary of the board or, in his or her absence, by another member designated by the board. In making that determination, the secretary of the board or board designee shall take into consideration the nature and length of the activity, the existence of any information warranting investigation prior to issuance of a certificate, the number of prior special activity certificates issued to the applicant, and any available information regarding prior performance while practicing in this state.

(F) If the application is complete and the secretary or board designee refuses or fails to authorize issuance of a special activity certificate prior to the initial date of the activity program, or event, the special activity certificate application shall be deemed converted to an application for a full license to practice medicine and surgery or osteopathic medicine and surgery to be processed under the provisions of Chapter 4731. of the Revised Code and this chapter of the Administrative Code. Failure to submit additional required fees or information required for full licensure may result in the application being considered abandoned as provided under rule 4731-6-22 of the Administrative Code.

(G) An individual may only apply six times within a consecutive two year period for a special activity certificate.

Eff 2-29-88 (Emer.), 6-6-88 (Emer.), 11-1-88, 12-19-88, 2-10-89, 8-15-93, 12-1-99; 10-31-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4731.05
Rule amplifies: RC 4731.091 , 4731.12 , 4731.13 , 4731.14 , 4731.142 , 4731.291 , 4731.292 , 4731.293 , 4731.294 , 4731.296
R.C. 119.032 review dates: 07/30/2004 and 10/31/2009

4731-6-34 Volunteer's certificates.

(A) A volunteer's certificate may be issued, without examination, to an applicant who is retired from practice and meets the eligibility requirements of section 4731.295 of the Revised Code, including having maintained for at least ten years prior to retirement full licensure in good standing in each jurisdiction in the United States that the applicant held such licensure or practiced for at least ten years in one or more branches of the armed services. Full licensure in good standing is a license or other authority granted by the appropriate entity or governmental body which lawfully permits the applicant to practice all branches of medicine and surgery or osteopathic medicine and surgery without government restriction or limitation.

(B) For purposes of issuance of a volunteer's certificate, an applicant shall be considered retired from practice if their license or certificate has been surrendered or allowed to expire with the intention of ceasing to practice medicine and surgery or osteopathic medicine and surgery for remuneration in this or any other state, without request to do so by the proper licensing authority of the state and without knowledge that they are the subject of an active investigation by the proper licensing authority of the state.

(C) The board may require the applicant to demonstrate present fitness to practice in the manner provided in section 4731.222 of the Revised Code before issuing a volunteer's certificate to an applicant whose certificate has been in an inactive status for more than two years or who has not been engaged in the active practice of his or her profession for more than two years.

(D) The holder of a volunteer's certificate may provide medical services only on the premises of a nonprofit shelter or health care facility and only to indigent and uninsured persons. The holder shall not accept any form of remuneration for providing medical services while in possession of the certificate.

(E) The holder of a volunteer's certificate shall not perform any operation or deliver babies, except in a medical emergency.

(F) The Board, pursuant to adjudicatory hearing under Chapter 119. of the Revised Code and by a vote of not fewer than six members, shall, to the extent permitted by law, limit, revoke, or suspend a certificate, refuse to register or refuse to reinstate an applicant, or reprimand or place on probation the holder of a certificate for a violation of a grounds for discipline pursuant to section 4731.22 of the Revised Code, including engaging in practice outside the scope of the volunteer's certificate.

(G) A volunteer's certificate shall be valid for a period of three years from its date of issuance. The board may renew a certificate upon proper application. The board shall not charge a fee for issuing or renewing a volunteer's certificate.

(H) To be eligible for renewal of a volunteer's certificate the holder of the certificate shall certify to the board completion of one hundred fifty hours of continuing medical education or its pro rata equivalent that meets the requirements of section 4731.281 of the Revised Code and the rules adopted under that section. The Board shall not renew a certificate if the holder has not complied with the continuing medical education requirements. The nonprofit shelter or health care facility in which the holder provides medical services may pay for or reimburse the holder for any costs incurred in obtaining the required continuing medical education credits.

Eff 2-29-88 (Emer.); 6-6-88 (Emer.); 11-1-88; 12-19-88; 2-10-89; 8-15-93; 10-31-96; 12-1-99; 10-31-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4731.05
Rule amplifies: 4731.091 , 4731.12 , 4731.13 , 4731.142 , 4731.22 , 4731.222 , 4731.281 , 4731.295
R.C. 119.032 review dates: 07/30/2004 and 10/31/2009