(a) Original documents may include, but are not limited to, those listed in subsections (b) and (c) of this section.
(b) Documentation required of all applicants for licensure.
  (1) evidence of relevant work experience, including a description of the applicant's responsibilities and of the duties that were performed;
  (2) Transcripts of courses taken and grades obtained from a college or university granting the applicant's degree and if required under these rules, a certificate of completion of training to demonstrate compliance with educational requirements of this chapter. If a college or university does not issue an official transcript, the board may accept another form of official documentation or sworn evidence of the degree or successful completion of courses.
  (3) a statement of the medical physics specialty for which the application is submitted;
  (4) three current professional references as follows:
    (A) two medical physicists. If the applicant is applying for one specialty, both physicists must be practicing in that specialty area. If the applicant is applying for two or more specialties, one physicist must be practicing in one of those specialties and the other physicist must be practicing in another one of the specialties for which the applicant is making application;
    (B) one licensed physician practicing in at least one of the specialties for which the applicant is making application; however, if the applicant is applying for a license in the specialty area of medical health physics, the physician may be practicing in diagnostic radiology, radiation oncology, or nuclear medicine;
    (C) if applying for a training license, post-secondary academic references may be substituted.
  (5) Birth Certificate/Proof of Age. Each applicant for licensure must provide a copy of a birth certificate and translation, if necessary, to prove that the applicant is at least 21 years of age. In instances where a birth certificate is not available the applicant must provide copies of a passport or other suitable alternate documentation.
  (6) Name change. Any applicant who submits documentation showing a name other than the name under which the applicant has applied must present copies of marriage licenses, divorce decrees, or court orders stating the name change. In cases where the applicant's name has been changed by naturalization, the applicant should send the original naturalization certificate by certified mail to the board office for inspection.
  (7) Examination verification. Each applicant for licensure must have the appropriate testing service(s) or testing boards, that administered the medical physicist specialty examination(s) required under this chapter, submit verification of the applicant's passage of the examination directly to the board.
  (8) Training license affidavit. Each applicant must submit a completed form, furnished by the board, titled "Training license Affidavit" prior to the issuance of a training license.
  (9) License verifications. Each applicant for licensure who is licensed, registered, or certified in another state must submit a copy of the license, registration or certificate issued by the relevant state board.
  (10) Criminal History record information.
    (A) Each applicant for a license must submit a complete and legible set of fingerprints, on a form prescribed by the Board, to medical board or to the Department of Public Safety for the purpose of obtaining criminal history record information from the Department of Public Safety and the Federal Bureau of Investigation.
    (B) the Board shall conduct a criminal history check of each applicant for a license using information:
      (i) provided by the applicant for license under this subsection;
      (ii) made available to the Board by the Department of Public Safety, the Federal Bureau of Investigation, and any other criminal justice agency under Chapter 411, Government Code.
  (11) National Practitioner Data Bank/Health Integrity and Protection Data Bank (NPDB-HIPDB). Each applicant must contact the NPDB-HIPDB and have a report of action submitted directly to the board on the applicant's behalf.
(c) Applicants may be required to submit other documentation, which may include the following:
  (1) Translations. Any document that is in a language other than the English language will need to have a certified translation prepared and a copy of the translation submitted with the translated document.
    (A) An official translation from the school or appropriate agency attached to the foreign language transcript or other document is acceptable.
    (B) If a foreign document is received without a translation, the board will send the applicant a copy of the document to be translated and returned to the board.
    (C) Documents must be translated by a translation agency who is a member of the American Translation Association or a United States college or university official.
    (D) The translation must be on the translator's letterhead, and the translator must verify that it is a "true word for word translation" to the best of his/her knowledge, and that he/she is fluent in the language translated, and is qualified to translate the document.
    (E) The translation must be signed in the presence of a notary public and then notarized. The translator's name must be printed below his/her signature. The notary public must use the phrase: "Subscribed and Sworn this _______ day of ________, 20___." The notary must then sign and date the translation, and affix his/her notary seal to the document.
  (2) Arrest records. If an applicant has ever been arrested the applicant must request that the arresting authority submit to the board copies of the arrest and arrest disposition.
  (3) Inpatient treatment for alcohol/substance disorder or mental illness. Each applicant that has been admitted to an inpatient facility within the last five years for treatment of alcohol/substance disorder or mental illness must submit the following:
    (A) applicant's statement explaining the circumstances of the inpatient treatment/hospitalization;
    (B) all records, submitted directly from the inpatient facility;
    (C) a statement from the applicant's treating physician/psychotherapist as to diagnosis, prognosis, medications prescribed, and follow-up treatment recommended; and
    (D) a copy of any contracts signed with any licensing authority, professional society or impaired practitioner committee.
  (4) Outpatient treatment for alcohol/substance disorder or mental illness. Each applicant that has been treated on an outpatient basis within the past five years for alcohol/substance disorder must submit the following:
    (A) applicant's statement explaining the circumstances of the outpatient treatment;
    (B) a statement from the applicant's treating physician/psychotherapist as to diagnosis, prognosis, medications prescribed, and follow-up treatment recommended; and
    (C) a copy of any contracts signed with any licensing authority, professional society or impaired practitioners committee.
  (5) Additional documentation. Any additional documentation required to facilitate the investigation of an application for licensure may be required of the applicant.
(d) The board may, in unusual circumstances, allow substitute documents where the applicant demonstrates exhaustive efforts to secure the required documents. These exceptions are reviewed by the board's executive director on a case-by-case basis.

Source Note: The provisions of this §160.9 adopted to be effective July 7, 2016, 41 TexReg 4819