Rule 4729:2-2-06 | Statement of preceptor and practical experience affidavit.
(A) At the beginning of internship, or if there is a change in preceptor or employment site, the intern must submit a completed statement of preceptor form within thirty days of the change to the state board of pharmacy. The filing of a statement of preceptor form is not required for a change of preceptor or internship site related to a school of pharmacy academic program.
(B) The intern is responsible for submitting the following required forms to certify the hour and supervision requirements pursuant to rule 4729:2-2-05 of the Administrative Code:
(1) A statement of preceptor form must be received by the state board of pharmacy for each pharmacy intern within thirty days of beginning an internship under a preceptor's supervision.
(a) No credit will be given for practical experience obtained prior to thirty days of the date that the statement of preceptor form is received by the board office; except, in the event of extraordinary circumstances and when due to no fault of the intern, the board may accept a retroactive date of filing for the statement of preceptor.
(b) The intern must file a statement of preceptor form whenever the intern changes internship sites and/or preceptors. The form must be submitted within thirty days of a change of internship site and/or preceptor.
(2) A practical experience affidavit form must be used to submit evidence of practical experience for internship credit.
(a) Practical experience reported on the affidavit shall be the total number of actual clock hours worked during the reported time period rounded to the nearest hour. The hours reported must be able to be documented by payroll or other records which may be examined by the state board of pharmacy upon request.
(b) Practical experience affidavits must be signed by the preceptor and submitted to the state board of pharmacy. In the event of the unavailability of the preceptor's signature due to extraordinary circumstances and due to no fault of the intern, the board may accept an alternative method for verification of a practical experience affidavit.
(c) Practical experience affidavits for a calendar year may be submitted at any time, except that they must be received in the board office or postmarked no later than the first day of March of the following year.
(d) No internship credit shall be granted by the board for practical experience obtained before licensure as an intern or during a period when the intern's license has lapsed.
(C) Statement of preceptor and practical experience affidavit forms may also be used to document any additional hours completed by the intern.