Acudetox Checklist of Supplemental Documentation

List of Supplemental Documentation

The following list is being provided to aid you in the completion of your application. The list is general and should in no way be considered a complete list for any one individual applicant. It is advisable that you collect all documentation and submit it in one packet, however we understand that there are some state licensing boards that will not send the documents to you but will send them directly to us.

Applicants (excluding Relicensure and Reissuance) must submit the following:

1. Copy of birth certificate, drivers license, or passport.
2. Copy of Acudetox Certificate.
3. Certified Acudetox training transcript request that the provider of the acudetox training course you attended submit this to you in an unopened envelope with the signature of the provider across the outside envelope flap.
4. State Board Licensure Verifications - contact each state, province or federal locale in which you have ever held a license or applied for a license as a health care professional and request that they furnish you a verification in a sealed envelope with the state board seal across the outside of the envelope. Some states may require that the verification be sent directly to the Texas Medical Board.
5. Verification of CCAOM Clean Needle Technique course contact the entity where you took this course and examination and request that they furnish you a verification in a sealed envelope with the providers signature across the outside of the envelope. This does not need to be provided if you were educated on Universal Infection Precautions as part of the Acudetox training course you attended.
6. Alternate Name - If you have recorded an alternate name on your application you are required to submit copies of documents that will support the name change. Those documents could be a marriage certificate, divorce decree, court ordered name change, or some other official document.

Recertification Applicants

If your certification has been canceled for non-payment or by request, you are required to meet current statutory requirements and board rules. Submit documentation of anything that is new or has changed since you were originally certified, as well as documentation that is non-static, such as state board verifications.

Reissuance Applicants

If your certification has been revoked by the board, you are required to meet current statutory requirements and board rules. In addition, you must furnish documentation that the reissuance of your certification is in your best interest and in the best interest of the public. Submit documentation of anything that is new or has changed since you were originally certified, as well as documentation that is non-static, such as state board verifications.