Idaho Statutes Title 39. Health and Safety § 39-6114A. Required application forms and documents for a national interest waiver request

(a) Evidence of recruiting efforts over a minimum of three (3) months prior to when the petitioning physician applied for the vacancy. This evidence must include documentation that the health care facility has utilized broad recruitment efforts and was unsuccessful;

(b) Evidence that the physician selected for the position visited the practice site;

(c) A list of physicians who applied for the position and the reason they were not selected;

(d) Evidence that the applicant has been providing medical or mental health care in Idaho for at least twelve (12) months or meets the requirements for a new start as defined in section 39-6105, Idaho Code. This includes but may not be limited to the Idaho taxpayer identification number, facility address, fax and telephone numbers, and staffing list;

(e) A copy of an employment contract between the physician and the applicant;

(f) Evidence that the employment site is in a federally determined area of underservice;

(g) A copy of the physician's license to practice medicine in the state of Idaho, or eligibility to apply for an Idaho license;

(h) Legible copies of any DS 2019 forms and other United States immigration documentation attesting to the physician's current legal status and history of stay in the United States;

(i) The physician's curriculum vitae; and

(j) Payment of the department's administrative application processing fee.