Division 150—State Board ofRegistration for the Healing Arts
Chapter 2—Licensing of Physiciansand Surgeons
4 CSR 150-2.001 Definitions
PURPOSE: This rule advises the public of thedefinitions which the board has adopted forcertain terms which are used in Chapter 334,RSMo.
(1) The term “extenuating circumstances,” asused in section 334.090, RSMo, shall meanthe existence of those circumstances underwhich an ordinary prudent person would nothave timely registered. Notwithstanding thepreviously mentioned, failure to receive arenewal notice is not an extenuating circum-stance.
(2) The term “hospitals approved by theboard,” as used in section 334.045, RSMo,shall mean all hospitals which are approvedand accredited to teach graduate medical edu-cation by the accreditation counsel on gradu-ate medical education of the AmericanMedical Association or the education com-mittee of the American OsteopathicAssociation.
(3) The term “reasonable intervals,” as usedin section 334.100.2(24)(d), RSMo, shallmean not less than annually.
(4) The term “timely pay,” as used in section334.100.2(4)(n), RSMo, shall mean anylicense renewal fee received by the boardwithin sixty (60) days of the license renewaldate.
(5) The term “American Specialty Board,” asused in Chapter 334, RSMo, and its accom-panying rules and regulations shall mean anyspecialty board formally recognized by theAmerican Board of Medical Specialties, theAmerican Medical Association or theAmerican Osteopathic Association.
AUTHORITY: sections 334.045 and 334.125,RSMo Supp. 1995 and 334.090 and 334.100,RSMo 1994.* Original rule filed Jan. 19,1988, effective April 15, 1988. Amended:Filed April 15, 1996, effective Nov. 30, 1996.
4 CSR 150-2.004 Postgraduate TrainingRequirements for Permanent Licensure
PURPOSE: Section 334.035, RSMo requiresevery applicant for a permanent license as aphysician and surgeon to provide the MissouriState Board of Registration for the HealingArts with satisfactory evidence of having suc-cessfully completed postgraduate training inhospitals, or medical or osteopathic collegesas the board may prescribe by rule. This ruleestablishes the postgraduate training require-ments which each applicant for a permanentlicense must satisfy. The board recognizesthat certain limited situations may occur inwhich it would be in the best interest of theinhabitants of this state for the board to waivethe postgraduate training requirements of thisrule. Therefore, this rule also establishes thecriteria which an applicant must fulfill beforethe board may waive the postgraduate train-ing requirements of this rule.
(1) Every applicant for a permanent licenseas a physician and surgeon who is a graduateof a medical college, approved and accreditedby the American Medical Association (AMA)or its Liaison Committee on MedicalEducation, or an osteopathic college ap-proved and accredited by the AmericanOsteopathic Association (AOA), must presenta certificate with his/her application evidenc-ing the satisfactory completion of one (1)year of postgraduate training in a programwhich is approved and accredited to teachpostgraduate medical education by theaccreditation counsel on graduate medicaleducation of the AMA or the education com-mittee of the AOA.
(2) Every applicant for a permanent licenseas a physician and surgeon who is not a grad-uate of a medical college, approved andaccredited by the AMA or its LiaisonCommittee on Medical Education, or anosteopathic college approved and accreditedby the AOA, must present, with his/her appli-cation, a certificate evidencing the satisfacto-ry completion of three (3) years of postgrad-uate training in one (1) recognized specialtyarea of medicine in a program which isapproved and accredited to teach postgradu-ate medical education by the accreditationcouncil on graduate medical education of theAMA or the education committee of theAOA.
(3) Notwithstanding the provisions of sec-tions (1) and (2) of this rule, the board maywaive any portion of the postgraduate trainingrequirements of this rule if the applicant isAmerican Specialty Board-eligible to take an
American Specialty Board-certifying exami-nation and the applicant has achieved a pass-ing score (as defined in this chapter) on alicensing examination administered in a stateor territory of the United States or theDistrict of Columbia. The board also maywaive any of the postgraduate trainingrequirements of this rule if the applicant is agraduate of a program approved and accredit-ed to teach medical education by theCanadian Royal College of Physicians andSurgeons and has one (1) year of postgradu-ate training in a program approved andaccredited to teach postgraduate medical edu-cation by the Canadian Royal College ofPhysicians and Surgeons. The board may alsowaive any of the postgraduate trainingrequirements of this rule if the applicant hasserved for three (3) or more years as a full-time faculty member of a medical collegeapproved and accredited by the AMA or itsLiaison Committee on Medical Education, oran osteopathic college approved and accredit-ed by the AOA. Prior to waiving any of thepostgraduate training requirements of thisrule, the board may require the applicant toachieve a passing score on one (1) of the fol-lowing: The Appropriate Specialty Board’scertifying examination in the physician’s fieldof specialization, Component 2 of theFederation Licensing Examination (FLEX)by December 31, 1993, Step 3 of the UnitedStates Medical Licensing Examination(USMLE), or the Federation of State MedicalBoards’ Special Purpose Examination(SPEX). If the board waives any of the post-graduate training requirements of this rule,then the license issued to the applicant maybe limited or restricted to the specialty areafor which the applicant is American SpecialtyBoard eligible.
AUTHORITY: sections 334.035, RSMo Supp.1987 and 334.125, RSMo 1986.* Emergencyrule filed Nov. 16, 1987, effective Dec. 31,1987, expired April 29, 1988. Original rulefiled Feb. 17, 1988, effective April 28, 1988.Amended: Filed Dec. 23, 1988, effectiveMay 1, 1989. Amended: Filed Jan. 3, 1991,effective June 10, 1991. Emergency amend-ment filed July 17, 1992, effective Aug. 1,1992, expired Nov. 28, 1992. Emergencyamendment filed Nov. 16, 1992, effectiveNov. 29, 1992, expired March 28, 1993.Amended: Filed July 17, 1992, effective April8, 1993. Amended: Filed Oct. 4, 1993, effec-tive April 9, 1994.
*Original authority: 334.035, RSMo 1987 and 334.125,RSMo 1959.
CODE OF STATE REGULATIONS 3Rebecca McDowell Cook (5/31/00)Secretary of State
Chapter 2—Licensing of Physicians and Surgeons 4 CSR 150-2
4 CSR 150-2.005 Examination Require-ments for Permanent Licensure
PURPOSE: Chapter 334, RSMo requireseach applicant for a permanent license as aphysician and surgeon to be examined by theboard. This rule specifies which examinationsare acceptable to the board, explains therequirements for achieving a passing score ona licensing examination, limits the number ofoccasions on which an applicant may attemptto achieve a passing score on a licensingexamination, requires additional postgradu-ate training before certain applicants may beexamined by the board, establishes criteriawhich must exist before the board may waivecertain requirements of this rule and autho-rizes the board to limit or restrict a licenseissued pursuant to a waiver of the require-ments of this rule.
(1) The board shall not issue a permanentlicense as a physician and surgeon to anyapplicant who has not met the qualificationsset forth under either subsection (1)(A), (B)or (C) of this rule:
(A) Applicant has received a passing scoreon either any of the following:
1. A licensing examination administeredin one (1) or more states or territories of theUnited States or the District of Columbia;
2. Components 1 and 2 of the FederationLicensing Examination (FLEX) beforeJanuary 1, 1994; or
3. Each of the three (3) Steps of theUnited States Medical Licensing Examina-tion (USMLE) within a seven (7)-year peri-od. Applicant shall not be deemed to havereceived a passing score on any Step of theUSMLE unless applicant has received a pass-ing score on that Step within three (3)attempts. Failure to pass any USMLE Stepshall be considered a failure to pass that Stepfor purposes of Missouri licensure, regardlessof the jurisdiction in which the Step wasadministered; or
4. One (1) of the hybrid combinations ofFLEX, USMLE, NBME (National Board ofMedical Examiners) and NBOE (NationalBoard of Osteopathic Examiners) examina-tions as set forth here, if completed beforeJanuary 1, 2000:NBOE Part I, NBME Part I or USMLE Step 1plus NBOE Part II, NBME Part II or USMLEStep 2plus NBOE Part III, NBME Part III or USMLEStep 3or
FLEX Component Iplus USMLE Step 3or NBOE Part I, NBME Part I or USMLEStep 1plus NBOE Part II, NBME Part II or USMLEStep 2plus FLEX Component 2; or
(B) Applicant has received a certificate ofthe NBME of the United States, charteredunder the laws of the District of Columbia ora certificate of the National Board ofExaminers for Osteopathic Physicians andSurgeons, chartered under the laws ofIndiana; or
(C) Applicant has received both a passingscore on the Licentiate of the MedicalCouncil of Canada (LMCC) and the medalistaward in either medicine or surgery from theRoyal College of Physicians and Surgeons.
(2) Beginning January 1, 1994, the licensingexamination administered by Missouri shallbe Part 3 of the USMLE.
(3) To receive a passing score, the applicantmust achieve a weighted average score of notless than seventy-five percent (75%) on theFLEX, a two-digit scaled score of not lessthan seventy-five (75) on the USMLE, or anaverage score of not less than seventy-five(75) on any other licensing examination.Applicants who have taken the FLEX exami-nation prior to 1985 may not average scoresfrom a portion of the examination taken atone (1) test administration with scores fromany other portion of the examination taken atanother test administration to achieve a pass-ing score. Applicants may not average scoresfrom different Steps of the USMLE or fromportions of different examinations in order toachieve a passing score.
(4) The board shall not issue a permanentlicense as a physician and surgeon or allowthe Missouri State Board examination to beadministered to any applicant who has failedto achieve a passing score cumulatively three(3) times or more on licensing examinationsadministered in one (1) or more states or ter-ritories of the United States, the District ofColumbia or Canada.
(5) The board shall not allow any applicant,who has failed to achieve a passing scorecumulatively two (2) times or more on licens-ing examinations administered in one (1) ormore states or territories of the United States,the District of Columbia or Canada to takethe licensing examination administered by the
board until the applicant has successfullycompleted one (1) additional year of post-graduate training in a program which isapproved and accredited to teach postgradu-ate medical education by the accreditationcounsel on graduate medical education of theAmerican Medical Association or the educa-tion committee of the American OsteopathicAssociation following the second unsuccess-ful attempt to pass a licensing examination.
(6) The board may waive the provisions ofsection (4) of this rule if the applicant isAmerican Specialty Board-certified, licensedto practice as a physician and surgeon inanother state of the United States or theDistrict of Columbia and the applicant hasachieved a passing score on a licensing exam-ination administered in a state or territory ofthe United States or the District of Columbia.Prior to waiving the provisions of section (4)of this rule, the board may require the appli-cant to achieve a passing score on one (1) ofthe following: The American SpecialtyBoard’s certifying examination in the physi-cian’s field of specialization, Part II of theFLEX or the Federation of State MedicalBoard’s Special Purpose Examination(SPEX). If the board waives the provisions ofsection (4) of this rule, then the license issuedto the applicant may be limited or restrictedto the applicant’s board specialty.
AUTHORITY: sections 334.031, 334.040,334.043 and 334.125, RSMo 1986.* Originalrule filed Feb. 17, 1988, effective May 12,1988. Amended: Filed Sept. 5, 1990, effec-tive Feb. 14, 1991. Emergency amendmentfiled July 17, 1992, effective Aug. 1, 1992,expired Nov. 28, 1992. Emergency amend-ment filed Nov. 16, 1992, effective Nov. 29,1992, expired March 28, 1993. Amended:Filed July 17, 1992, effective April 8, 1993.Amended: Filed Oct. 4, 1993, effective April9, 1994.
4 CSR 150-2.010 Applicants for Licensingby Examination
PURPOSE: This rule provides requirementsto applicants desiring to take the examinationin Missouri for permanent licensure to prac-tice as a physician and a surgeon.
(1) The applicant shall furnish satisfactoryevidence as to his/her innocence of unprofes-sional or dishonorable conduct and good
4 CODE OF STATE REGULATIONS (5/31/00) Rebecca McDowell CookSecretary of State
4 CSR 150-2—ECONOMIC DEVELOPMENT Division 150—State Board of Registration for the Healing Arts
moral character, including postgraduate ref-erence letters from the applicant’s trainingprograms.
(2) The applicant shall furnish a certificate ofgraduation from an accredited high school,satisfactory evidence of completion of pre-professional education consisting of a mini-mum sixty (60) semester hours of collegecredit in acceptable subjects from a reputablecollege or university approved by the board.
(3) The applicant shall furnish satisfactoryevidence of having attended throughout atleast four (4) terms of thirty-two (32) weeksof actual instructions in each term and of hav-ing received a diploma from some reputablemedical or osteopathic college that enforcesrequirements of four (4) terms of thirty-two(32) weeks for actual instruction in eachterm, including, in addition to class work,experience in operative and hospital workduring the last two (2) years of instruction asis required by the American MedicalAssociation (AMA) and the AmericanOsteopathic Association (AOA) before thecollege is approved and accredited as rep-utable.
(4) All applicants shall have on file, in theoffice of the executive director, a photocopyof their professional degrees before licensescan be issued to them.
(5) For applicants desiring to take the board’sexamination after January 1, 1994, the appli-cant shall furnish satisfactory evidence ofhaving passed—
(A) Component 1 of the FederationLicensing Examination (FLEX); or
(B) Both—1. Part I of the NBME (National Board
of Medical Examiners) examination, Part I ofthe NBOE (National Board of OsteopathicExaminers) examination or Step 1 of theUSMLE (United States Medical LicensingExamination); and
2. Part II of the NBME examination orPart II of the NBOE examination or Step 2 ofthe USMLE.
(6) For applicants desiring to take the exami-nation after January 1, 1994, the applicantshall provide evidence that the applicant willhave met the board’s postgraduate trainingrequirements as stated in 4 CSR 150-2.004,within sixty (60) days of the examination.
(7) Upon proper showing, the State Board ofRegistration for the Healing Arts may acceptthe certificate of the National Board ofMedical Examiners of the United States,chartered under the laws of the District of
Columbia, of The National Board ofExaminers for Osteopathic Physicians andSurgeons, chartered under the laws ofIndiana, in lieu of and as equivalent to itsown professional examination, upon properapplication and an appropriate fee to beestablished by the board.
(8) The board does not necessarily accept theoperative and hospital work of any medical orosteopathic school outside the United Statesand Canada; therefore an applicant from aninternational school may be required to haveat least three (3) years of AMA/AOAapproved training in a hospital in the UnitedStates approved for resident training by theboard before making application for examina-tion.
(A) This applicant must furnish to theboard a copy of his/her credentials in theoriginal form with translated copy of eachattached and shall be verified to the board bythe school of graduation direct or documentsbearing the evidence shall be visaed by theUnited States consul in the country the schoolof graduation is or was located.
(B) This applicant is required to get a cer-tificate from the Educational Commission forForeign Medical Graduates or show evidenceto the board that s/he has passed the equiva-lent examination in another state or nationalboard.
(9) Medical or osteopathic colleges inCanada, at the discretion of the board, maynot be considered international schools by theState Board of Registration for the HealingArts.
State Board of Registration for the HealingArts of Missouri v. De Vore, 517 SW2d 480(Mo. App. 1975). Administrative HearingCommission Act, section 161.252, RSMo(1969), repealed the former authority of theboard to conduct evidentiary hearings on thequalifications of applicants for licensure.
State Board of Registration for the HealingArts of Missouri v. Masters, 512 SW2d 150(Mo. App. 1974). Board’s refusal to issueosteopath an annual certificate of registration
held not tantamount to refusal to renewlicense as would give Administrative HearingCommission jurisdiction and authority.
State Board of Registration for the HealingArts of Missouri v. Masters, 512 SW2d 150(Mo. App. 1974). Board may not issue annu-al certificate of registration to person who isnot licensed to practice medicine in this state.
Op. Atty. Gen. No. 257, Goode (6-1-70).Pathology is a branch of the practice ofmedicine within the provisions of Chapter334, RSMo (1969) and a profession under thejurisdiction of the State Board of Registrationfor the Healing Arts, and that an individualmust be licensed by the board before s/he canlawfully practice pathology. The prosecutingand circuit attorneys have the responsibilityfor criminal prosecutions arising out of viola-tions of Chapter 334.
Op. Atty. Gen. No. 82, Hardwicke (3-1-65).Physicians who accept professional staffappointments in Missouri hospitals and regu-larly practice medicine and surgery in thosehospitals are maintaining an “appointedplace to meet patients or receive calls withinthe limits of this state.” These physicians arerequired to have a Missouri license.
Op. Atty. Gen. No. 36, Hailey (3-29-55). Aphysician who is not licensed in the state ofMissouri may not engage in activities consti-tuting the practice of medicine within thestate, regardless of who his/her employer maybe or under whose supervision s/he may doso.
4 CSR 150-2.015 Determination of Com-petency
PURPOSE: This rule complies with the pro-visions of section 334.100.2(24), RSMo andspecifies the procedures to be followed underthis statute in determining competency.
(1) Whenever the board has reason to believethat a physician or surgeon is unable to prac-tice with reasonable skill and safety topatients by reasons of incompetency, illness,drunkenness, excessive use of drugs, nar-cotics, chemicals or as a result of any mentalor physical condition, the board may hold ahearing to determine whether probable causeexists to reexamine to establish competencyin a specialty, examine a pattern and practiceof professional conduct or to examine todetermine mental or physical competency, orboth.
CODE OF STATE REGULATIONS 5Rebecca McDowell Cook (5/31/00)Secretary of State
Chapter 2—Licensing of Physicians and Surgeons 4 CSR 150-2
(2) Notice of the probable cause hearing shallbe served on the licensee within a reasonableamount of time before the hearing, but in noevent later than ten (10) days before the hear-ing.
(3) Following the probable cause hearing andupon a finding by the board that probablecause exists to determine a physician’s or sur-geon’s competency, the board shall issue anorder setting forth the allegations leading to afinding of probable cause, the method of fur-ther determination of competency, theinstructions to the competency panel, thetime frame for determination and the finalorder to be issued by the board in the eventthe physician fails to designate an examiningphysician to the board or fails to submit to anexamination when directed. The board mayinclude the reasonable intervals at which thephysician may be given an opportunity todemonstrate competency.
(4) Members of the competency panel shallbe licensed to practice the healing arts inMissouri. Panels which review physicianswho graduated from a medical school accred-ited by the American Medical Association(AMA) shall be composed of graduates froman AMA-accredited medical school. Panelswhich review physicians who graduated froma medical school accredited by the AmericanOsteopathic Association (AOA) shall be com-posed of graduates from an AOA- accreditedmedical school. The panel shall be reim-bursed by the board for reasonable and nec-essary expenses, and at a per-diem rate iden-tical to that provided for Board of HealingArts members in section 334.120, RSMo.Neither the physician nor the board shall payor make any other compensation of any kindto the panel for its review.
(5) Following a determination by the panel,the panel shall make one (1) majority writtenreport to the board either that the physicianexamined is able to practice with reasonableskill and safety to patients or that the physi-cian examined is unable to practice with rea-sonable skill and safety to patients and spec-ify the reasons or grounds for the opinion.
(6) Upon receipt of the written report fromthe panel, the board shall serve the physicianwith a copy of the report and notify the physi-cian of the time, date and place of the meet-ing at which the board will formally acceptand review the findings of the panel anddetermine a final order of discipline based onthe evidence presented by the written reportof the panel and any other evidence that per-tains to the issue of the final order of disci-pline to be imposed.
AUTHORITY: section 334.100, RSMo Supp.1990.* Original rule filed Oct. 14, 1976,effective Jan. 13, 1977. Rescinded and read-opted: Filed Dec. 13, 1989, effective April 1,1990.
State Board of Registration for the HealingArts of Missouri v. De Vore, 517 SW2d 480(Mo. App. 1975). Administrative HearingCommission Act section 161.252, RSMo(1969) repealed the former authority of theboard to conduct evidentiary hearings on thequalifications of applicants for licensure.
4 CSR 150-2.030 Licensing by Reciprocity
PURPOSE: This rule provides information tothose applicants desiring licensure byreciprocity.
(1) The applicant shall furnish a postgraduatereference letter from each institution wheres/he is a house officer, meaning either internor resident.
(2) The applicant shall furnish a certificate ofgraduation from an accredited high school.Satisfactory evidence of completion of pre-professional education consisting of a mini-mum of sixty (60) semester hours of college
credit in acceptable subjects from a reputablecollege or university approved by the board.
(3) The applicant shall furnish satisfactoryevidence of having attended throughout atleast four (4) terms of thirty-two (32) weeksof actual instructions in each term of a pro-fessional college recognized as reputable bythe board and of having received a diplomafrom a professional college recognized asreputable by the board.
(4) Applicants for licensing by reciprocitywho have been examined successfully by anyprofessional board considered competent bythe Missouri State Board of Registration forthe Healing Arts, and having received gradesnot less than those required by the board, andholding certificates as physicians and sur-geons in any state or territory of the UnitedStates or the District of Columbia and, inaddition, presenting to the board satisfactorycertificates that they in every way fulfilled allthe scholastic and other requirements of theMissouri State Board of Registration for theHealing Arts, at the discretion of the board,and upon showing to the State Board ofRegistration for the Healing Arts may receivefrom the board a license to practice as aphysician and surgeon in Missouri withoutfurther examination. Applicants may berequired to appear before the board in per-son.
(5) The applicant is required to make appli-cation (see 4 CSR 150-2.040) upon a formprepared by the board.
(6) No application will be considered unlessfully and completely made out on the speci-fied form properly attested.
(7) An applicant for reciprocity shall present,attached to the application, a recent photo-graph, not larger than three and one-halfinches by five inches (3 1/2" × 5").
(8) Applications shall be sent to the executivedirector of the State Board of Registration forthe Healing Arts, P.O. Box 4, Jefferson City,MO 65102.
(9) The fee for reciprocity shall be an appro-priate fee to be established by the board. Thefee shall be sent in the form of a bank draftor post office money order or express moneyorder. Personal checks will not be accepted.
(10) The applicant shall furnish, on a formprescribed by the board, verification of licen-sure from every state, territory or interna-tional country in which the applicant has everbeen licensed to practice the healing arts.
6 CODE OF STATE REGULATIONS (5/31/00) Rebecca McDowell CookSecretary of State
4 CSR 150-2—ECONOMIC DEVELOPMENT Division 150—State Board of Registration for the Healing Arts
(11) The professional diploma and verifica-tion of licensure shall be sent to the execu-tive director of the State Board ofRegistration for the Healing Arts for verifica-tion. Photocopies of the documents may beaccepted at the discretion of the board.
(12) When an applicant has filed his/herapplication and an appropriate fee, to beestablished by the board, for licensure byreciprocity and the application is denied bythe board or subsequently withdrawn by theapplicant, an appropriate fee established bythe board will be retained by the State Boardof Registration for the Healing Arts as a ser-vice charge.
(13) An applicant who cumulatively three (3)times or more has failed a licensing examina-tion administered in one (1) or more states orterritories of the United States or the Districtof Columbia will not be licensed by reciproc-ity in this state by the board.
AUTHORITY: section 334.125, RSMo Supp.1995.* This version of rule filed Dec. 19,1975, effective Dec. 29, 1975. Amended:Filed Jan. 13, 1982, effective April 11, 1982.Amended: Filed Dec. 23, 1988, effective May1, 1989. Amended: April 15, 1996, effectiveNov. 30, 1996.
State Board of Registration for the HealingArts of Missouri v. De Vore, 517 SW2d 480(Mo. App. 1975). Administrative HearingCommission Act section 161.252, RSMo(1969) repealed the former authority of theboard to conduct evidentiary hearings on thequalifications of applicants for licensure.
State Board of Registration for the HealingArts of Missouri v. Masters, 512 SW2d 150(Mo. App. 1974). Board may not issue annu-al certificate of registration to person who isnot licensed to practice medicine in this state.
Op. Atty. Gen. No. 257, Goode (6-1-70).Pathology is a branch of the practice ofmedicine within the provisions of Chapter334, RSMo (1969) and a profession under thejurisdiction of the State Board of Registrationfor the Healing Arts, and that an individualmust be licensed by the board before s/he canlawfully practice pathology. The prosecutingand circuit attorneys have the responsibilityfor criminal prosecutions arising out of viola-tions of Chapter 334.
Op. Atty. Gen. No. 82, Hardwicke (3-1-65).Physicians who accept professional staffappointments in Missouri hospitals and regu-
larly practice medicine and surgery in thosehospitals are maintaining an “appointedplace to meet patients or receive calls withinthe limits of this state.” These physicians arerequired to have a Missouri license.
Op. Atty. Gen. No. 36, Hailey (3-29-55). Aphysician who is not licensed in the state ofMissouri may not engage in activities consti-tuting the practice of medicine within thestate, regardless of who his/her employer maybe or under whose supervision s/he may doso.
CODE OF STATE REGULATIONS 7Rebecca McDowell Cook (5/31/00)Secretary of State
Chapter 2—Licensing of Physicians and Surgeons 4 CSR 150-2
8 CODE OF STATE REGULATIONS (5/31/00) Rebecca McDowell CookSecretary of State
4 CSR 150-2—ECONOMIC DEVELOPMENT Division 150—State Board of Registration for the Healing Arts
4 CSR 150-2.040 Application Forms
PURPOSE: This rule provides instructionsfor filing applications in the office of the StateBoard of Registration for the Healing Artsrequesting permanent licensure in Missouri.
(1) The applicant is required to make appli-cation upon the form prepared by the board.
(2) No application will be considered unlessfully and completely made out on the speci-fied form and properly attested.
(3) Applications shall be sent to the executivedirector of the State Board of Registration forthe Healing Arts, P.O. Box 4, Jefferson City,MO 65102.
(4) The board shall charge an appropriate feeestablished by the board to each personapplying to and appearing before it for exam-ination for certificate of licensure to practiceas a physician and surgeon. The fee shall besent in the form of a bank draft, post officemoney order or express money order.Personal checks will not be accepted.
(5) A copy of the professional degree shall besent to the executive director of the StateBoard of Registration for the Healing Arts forverification.
(6) When an applicant has one (1) or moreyears in a preprofessional or professionalinstitution other than the one from which s/heis a graduate, s/he must file with the applica-tion a statement under seal from those insti-tutions showing time spent and creditreceived.
(7) An applicant may withdraw his/her appli-cation for licensure anytime prior to theboard’s vote on his/her candidacy for licen-sure. In the event that an applicant withdrawshis/her application, the appropriate fee estab-lished by the board will be retained by theState Board of Registration for the HealingArts as a service charge.
State Board of Registration for the HealingArts of Missouri v. De Vore, 517 SW2d 480(Mo. App. 1975). Administrative HearingCommission Act section 161.252, RSMo
(1969) repealed the former authority of theboard to conduct evidentiary hearings on thequalifications of applicants for licensure.
CODE OF STATE REGULATIONS 9Rebecca McDowell Cook (5/31/00)Secretary of State
Chapter 2—Licensing of Physicians and Surgeons 4 CSR 150-2
10 CODE OF STATE REGULATIONS (5/31/00) Rebecca McDowell CookSecretary of State
4 CSR 150-2—ECONOMIC DEVELOPMENT Division 150—State Board of Registration for the Healing Arts
CODE OF STATE REGULATIONS 11Rebecca McDowell Cook (5/31/00)Secretary of State
Chapter 2—Licensing of Physicians and Surgeons 4 CSR 150-2
12 CODE OF STATE REGULATIONS (5/31/00) Rebecca McDowell CookSecretary of State
4 CSR 150-2—ECONOMIC DEVELOPMENT Division 150—State Board of Registration for the Healing Arts
CODE OF STATE REGULATIONS 13Rebecca McDowell Cook (5/31/00)Secretary of State
Chapter 2—Licensing of Physicians and Surgeons 4 CSR 150-2
14 CODE OF STATE REGULATIONS (5/31/00) Rebecca McDowell CookSecretary of State
4 CSR 150-2—ECONOMIC DEVELOPMENT Division 150—State Board of Registration for the Healing Arts
CODE OF STATE REGULATIONS 15Rebecca McDowell Cook (5/31/00)Secretary of State
Chapter 2—Licensing of Physicians and Surgeons 4 CSR 150-2
16 CODE OF STATE REGULATIONS (5/31/00) Rebecca McDowell CookSecretary of State
4 CSR 150-2—ECONOMIC DEVELOPMENT Division 150—State Board of Registration for the Healing Arts
CODE OF STATE REGULATIONS 17Rebecca McDowell Cook (5/31/00)Secretary of State
Chapter 2—Licensing of Physicians and Surgeons 4 CSR 150-2
4 CSR 150-2.050 Annual RegistrationPenalty
PURPOSE: This rule provides information tophysicians and surgeons permanentlylicensed in Missouri regarding penalty of notregistering annually.
(1) Whenever a licensed practitioner fails torenew his/her registration for any period inexcess of six (6) months after the expirationof his/her last prior registration, his/herapplication for renewal of registration shall bedenied unless it is accompanied by all feesrequired by statute and this rule, togetherwith a statement of all addresses where s/hehas practiced and resided since the expirationof his/her last period of registration, thenature of his/her practice since the expirationand whether, since the expiration, any licenseor right of his/her to practice in any otherstate or country has been suspended orrevoked; whether s/he has been the subject ofany disciplinary action by any licensing agen-cy of any state or country or by any profes-sional organization or society; whether s/hehas been charged or convicted of any crimein any court of any state or country; whethers/he has been addicted to a drug habit or hasbeen guilty of any unprofessional or dishon-orable conduct as defined by section334.100, RSMo, and all details pertaining toall such occurrences. This statement shall becompleted upon forms provided by the exec-utive secretary and shall be made by theapplicant under oath.
State Board of Registration for the HealingArts of Missouri v. Masters, 512 SW2d 150(Mo. App. 1974). Board’s refusal to issueosteopath an annual certificate of registrationheld not tantamount to refusal to renewlicense as would give Administrative HearingCommission jurisdiction and authority.
4 CSR 150-2.060 Temporary Licenses
PURPOSE: This rule provides information toapplicant and American Medical Associa-tion/American Osteopathic Association-approved hospitals of the requirements fortemporary licenses.
(1) The applicant is required to make appli-cation upon a form prepared by the board.
(2) No application will be considered unlessfully and completely made out on the speci-fied form and properly attested.
(3) An applicant shall present properlyattached to the application blank with theapplication one (1) photograph not largerthan three and one-half inches by five inch-es (3 1/2" × 5").
(4) Applicants applying for licensure whohave graduated from schools outside theUnited States or Canada must have and showproof of a permanent Educational Commis-sion for Foreign Medical Graduates(ECFMG) certificate or show evidence to theboard that applicant has passed the equivalentlicensing board examination in another state.
(5) Completed applications shall be sent bythe superintendent of the hospital where theapplicant is to be in an approved training pro-gram to the executive director of the StateBoard of Registration for the Healing Arts,P.O. Box 4, Jefferson City, MO 65102. Thisrequirement does not relieve the applicant ofthe responsibility for the filing of the applica-tion and no applicant shall begin practicinguntil the temporary license has been issued.
(6) The board shall charge each person apply-ing to it for certificate of temporary licensureto practice as a physician and surgeon inMissouri an appropriate fee to be establishedby the board. An appropriate fee shall becharged annually in the event the temporarylicense is renewed. The fee shall be sent inthe form of a bank draft or post office moneyorder or express money order. Personalchecks will not be accepted.
(7) The applicant shall secure a recommen-dation of his/her moral, ethical and profes-sional conduct from the superintendent, chiefof staff, or both, in the hospital in which s/hedesires to work.
(A) Applicants shall notify the board whenthey leave the hospital where they areemployed or where they are engaged in atraining program. The applicant’s temporarylicense shall expire immediately on the appli-cant’s leaving the training program.
(B) The superintendent or director of thehospital shall notify the executive directorwhen a temporary licensee ceases his/heremployment or training at the hospital.
(C) An applicant or a temporary licenseewill be required to appear before the boardwhenever directed by the board.
(8) The executive director will sign the tem-porary license.
(9) A letter shall be sent to the chief execu-tive officer and the director of the trainingprogram to inform them of the board’s deci-sion to approve or deny issuance of the tem-porary license to the applicant.
(10) The board may terminate a temporarylicense at its own discretion.
(11) The superintendent or other officials ofhospitals approved by the board for tempo-rary licensure are to furnish the executivedirector a list of personnel employed in thehospitals as of January 15 and July 15 of eachyear. Failure of the superintendent or otherresponsible official to furnish the executivedirector this list, at the discretion of theboard, may result in the withdrawal ofapproval of the hospital.
(12) The applicant must file photostaticcopies and official translations of his/hermedical credentials with the applications.
(13) Applicants who are graduates ofapproved schools in the United States and areserving as interns, residents or fellows in hos-pitals approved by the board for temporarylicensure in Missouri, must furnish satisfac-tory evidence of having attended an approvedschool and receiving their degrees by filing aphotostatic copy of the professional diplomawith the application.
(14) A temporary license may be issued to aphysician hired by a state-maintained hospitaluntil s/he can take the next examinationoffered by the board for permanent licensure,provided that the physician has one (1) yearof approved training in the United States.
(15) A temporary licensee holding the posi-tion of a staff physician in a state-maintainedhospital who fails the examination for perma-nent licensure may not continue in the statusof a staff physician but may enter anAmerican Medical Association/AmericanOsteopathic Association (AMA/AOA)-approved training program. A temporarylicensee who is in an AMA/AOA-approvedtraining program and fails the examination forpermanent licensure may continue in thetraining program until the next regular exam-ination.
(16) A temporary license may be issued tophysicians who are otherwise qualified byreason of their employment in state-main-tained hospitals or enrollment in an approvedtraining program for sabbatical service inMissouri, but this license may not berenewed.
(17) A temporary license must be renewedannually. The initial temporary license shallexpire on the first day of January or the firstday of July following initial issuancewhichever date is closer to the date of initialissuance and shall be renewed on or beforethe first anniversary of its expiration. Anyrenewal request not received within fifteen(15) days of the expiration date must beaccompanied by a statement in writing fromthe applicant’s training program explaining tothe satisfaction of the board the delay inrequesting renewal and a statement explainingwhat the applicant has been doing during theperiod of lapse. No temporary licensee shallcontinue to practice beyond the expirationdate of the initial license or any renewalunless his/her license has been properlyrenewed.
(18) After January 1, 1978, no temporarylicense will be renewed unless the applicantor licensee provides the board with satisfac-tory evidence of having obtained one (1) yearof training in an AMA/AOA-approved train-ing program in the United States.
(19) The holder of a temporary license issuedby the State Board of Registration for theHealing Arts may be authorized to prescribelegend drugs, including controlled substancesfor those patients cared for within the frame-work of the AMA/AOA-approved trainingprogram in which s/he is enrolled. The insti-tution’s Drug Enforcement Administrationnumber, with a distinguishing suffix approvedby the Bureau of Narcotics and DangerousDrugs of Missouri, shall be used by the tem-porary licensee to demonstrate this authority.
State Board of Registration for the HealingArts of Missouri v. De Vore, 517 SW2d 480(Mo. App. 1975). Administrative HearingCommission Act section 161.252, RSMo(1969) repealed the former authority of theboard to conduct evidentiary hearings on thequalifications of applicants for licensure.
State Board of Registration for the HealingArts of Missouri v. Masters, 512 SW2d 150(Mo. App. 1974). Board may not issue annu-al certificate of registration to person who isnot licensed to practice medicine in this state.
Op. Atty. Gen. No. 257, Goode (6-1-70).Pathology is a branch of the practice ofmedicine within the provisions of Chapter334, RSMo (1969) and a profession under thejurisdiction of the State Board of Registrationfor the Healing Arts, and that an individualmust be licensed by the board before s/he canlawfully practice pathology. The prosecutingand circuit attorneys have the responsibilityfor criminal prosecutions arising out of viola-tions of Chapter 334.
Op. Atty. Gen. No. 82, Hardwicke (3-1-65).Physicians who accept professional staffappointments in Missouri hospitals and regu-larly practice medicine and surgery in thosehospitals are maintaining an “appointedplace to meet patients or receive calls withinthe limits of this state.” These physicians arerequired to have a Missouri license.
Op. Atty. Gen. No. 36, Hailey (3-29-55). Aphysician who is not licensed in the state ofMissouri may not engage in activities consti-tuting the practice of medicine within thestate, regardless of who his/her employer maybe or under whose supervision s/he may doso.
18 CODE OF STATE REGULATIONS (5/31/00) Rebecca McDowell CookSecretary of State
4 CSR 150-2—ECONOMIC DEVELOPMENT Division 150—State Board of Registration for the Healing Arts
CODE OF STATE REGULATIONS 19Rebecca McDowell Cook (5/31/00)Secretary of State
Chapter 2—Licensing of Physicians and Surgeons 4 CSR 150-2
20 CODE OF STATE REGULATIONS (5/31/00) Rebecca McDowell CookSecretary of State
4 CSR 150-2—ECONOMIC DEVELOPMENT Division 150—State Board of Registration for the Healing Arts
CODE OF STATE REGULATIONS 21Rebecca McDowell Cook (5/31/00)Secretary of State
Chapter 2—Licensing of Physicians and Surgeons 4 CSR 150-2
22 CODE OF STATE REGULATIONS (5/31/00) Rebecca McDowell CookSecretary of State
4 CSR 150-2—ECONOMIC DEVELOPMENT Division 150—State Board of Registration for the Healing Arts
CODE OF STATE REGULATIONS 23Rebecca McDowell Cook (5/31/00)Secretary of State
Chapter 2—Licensing of Physicians and Surgeons 4 CSR 150-2
24 CODE OF STATE REGULATIONS (5/31/00) Rebecca McDowell CookSecretary of State
4 CSR 150-2—ECONOMIC DEVELOPMENT Division 150—State Board of Registration for the Healing Arts
