Basic Criteria Required for All Evaluators: 

• Must hold a degree from an accredited college in the applicable profession.   
• Must hold an active and pertinent professional license in the applicable jurisdiction. 
• Must have obtained the appropriate specialty certification/additional professional credentials required for a particular specialty.  
• Must use a set of generally recognized evaluation criteria.  
• Demonstrated experience/understanding of administrative law, evaluation of fitness for duty of the health care professional and safe-to-practice evaluations for health care professionals.  
• Must have no disciplinary or criminal history of a misdemeanor involving moral turpitude or a felony.  Exception:  Addictionologist must have no disciplinary action within the last five years.  
• Has no preexisting doctor/patient relationship with the licensee.  
• Must have five (5) years of experience performing the applicable type of evaluation 
• Must apply an established evaluation purpose protocol generally accepted by the profession for evaluation of fitness for duty or safety to practice for health care professionals.  

Application Requirements for all Evaluators:  

• Resume
• Two references regarding professional experience performing evaluations for the purpose of determining safe-to-practice status
• Outline of established evaluation purpose protocol
• Outline of evaluation components
• Signed statement that there is no prior doctor/patient relationship
•  Signed statement that the evaluator understands the evaluation is strictly for the purpose of determining fitness for duty and safety to practice of the health care professional
• Signed statement that the evaluator understands that they cannot be the treating physician for the licensee for the purpose of compliance with a Board Order
• Signed statement that the evaluator has not had a license in this or any other jurisdiction disciplined for any reason.  Exception:  Addictionologist must have no disciplinary action within the last five years.
• Signed statement that the evaluator has not been convicted or pled guilty to a misdemeanor involving moral turpitude or a felony

Physical

Credentials:

• M.D., D.O., D.C., or N.T.  
• May be restricted to a specific type of license or specialty based on the reason for the evaluation.  

Evaluation Components:

• Components depend on the reason for evaluation. Board staff will determine the criteria.

Evaluation Purpose:

• Evaluation of the respondent’s physical ability to practice chiropractic safely and skillfully and/or identify physical restrictions to practice.
• Evaluation of respondent’s amenability for treatment and prognosis for intervention, if applicable.
• Evaluation of conditions, situations and issues that may interfere with ability to practice safely and skillfully or may interfere with completion of treatment, if applicable.    

Neurological

Credentials:

• • M.D. or D.O. with a Neurological specialty certification  

Evaluation Components:

• MRI
• EEG
• Neurological review:

1. VS/Orientation
2. Speech/language
3. Cranial nerves
4. Motor
5. Cerebellar
6. Sensory
7. Reflex
8. Ambulation •

• Review of Systems:

1. Vitals
2. HEENT
3. Neck
4. Coronary
5. Lungs
6. Abdomen
7. Extremities  

Evaluation Purpose:

• Evaluation of the respondent’s physical and mental ability to practice chiropractic safely and skillfully and or physical restrictions to practice.
• Evaluation of respondent’s amenability for treatment, and prognosis for intervention, if applicable.
• Evaluation of conditions, situations and, issues that may interfere with the ability to practice safely and skillfully or may interfere with the completion of treatment, if applicable. 

Psychological

Credentials:

• Ph.D. or Phy.D.  

Evaluation Components:

• Components depend on the reason for evaluation. Board staff will determine the criteria.  

Evaluation Purpose:

• Evaluation of the respondent’s mental/behavioral ability to practice chiropractic safely and skillfully.
• Evaluation of respondent’s reliability as a self-reporter.
• Evaluation of respondent’s amenability for treatment and prognosis for intervention, if applicable.
• Evaluation of conditions, situations and issues that may interfere with respondent’s ability to practice safely and skillfully or interfere with successful completion of treatment.
• Recommendation with regard to community supervision and clinical management.    

Psychiatric

Credentials: 

• M.D. with a specialty in Psychiatry

Evaluation Components:

• Components depend on the reason for evaluation. Board staff will determine the criteria.  

Evaluation Purpose:

• Evaluation of the respondent’s mental ability to practice chiropractic safely and skillfully.
• Evaluation of respondent’s reliability as a self-reporter.
• Evaluation of respondent’s amenability for treatment and prognosis for intervention, if applicable.
• Evaluation of conditions, situations and issues that may interfere with respondent’s ability to practice safely and skillfully or interfere with the successful completion of treatment.
• Recommendation with regard to community supervision and clinical management.   

Neuropsychiatric  

Credentials:

• M.D. with Neurological specialty, Ph.D. or Psy.D.  

Evaluation Components:

• Clinical Interview to include history.
• Basis of evaluation to include:

1. Adult substance abuse survey
2. Wechsler Adult Intelligence Scale
3. Halstead Reitan Neuropsychological test battery for adults.
4. California Verbal Learning Test
5. Minnesota Multiphasic Personality
6. Review of Board/investigative record

•  Behavioral observation
• Substance abuse survey
• Cognitive and Intellectual functioning
• Personality and emotional factors.
• Established evaluation purpose protocol.  

Evaluation Purpose:

• Evaluation of the respondent’s mental ability to practice chiropractic safely and skillfully.
• Evaluation of respondent’s reliability as a self-reporter.
• Evaluation of respondent’s amenability for treatment and prognosis for intervention, if applicable.
• Evaluation of conditions, situations and issues that may interfere with respondent’s ability to practice safely and skillfully or interfere with the successful completion of treatment.
• Recommendation with regard to community supervision and clinical management. 

Psychosexual/Psychophysiological 

Credentials

Psychosexual:

•  Ph.D. with ABPP, LMFT and CSAT •

Psychophysiological:

• M.D. or D.O.  

Evaluation Components:

• Clinical Interview

1. Mental status
2. Sexual history 

• Minnesota Multiphasic Personality Inventory III
• Polygraph
• Personality Assessment Inventory
• Millon Clinical Multiaxial Inventory
• Multiphasic Sex Inventory II
• Shipley Institute of Living Scale • Abel Assessment 3.1
• Group session observation
• Review of Board/investigative record
• Established evaluation purpose protocol as per below  

Evaluation Purpose:

• Evaluation of respondent’s reliability as a self-reporter.
• Evaluation of respondent’s continuum of sexual interest based on self-report and Able assessment.
• Evaluation of respondent’s social, cognitive and sexual deficits that may allow for the cultivation and/or habituation of sex deviant patterns.
• Evaluation of respondent’s amenability for treatment and prognosis of intervention.
• Evaluation of conditions, situations and issues that may interfere with or contribute to a more successful prognosis or successful completion of treatment.
• Recommendation with regard to community supervision and clinical management. 

Addiction

Credentials:

• M.D. or D.O. with certification from the American Society of Addiction Medicine/American Board of Addiction Medicine or a specialty in psychiatry with experience in addiction medicine.  

Evaluation Components:

• History

1. Chemical dependency
2. Physical
3. Social
4. Family
5. Psychological/psychiatric

• Mental Status Examination
• Medication review
• Review of physical and psychological systems
• Michigan Alcoholism Screening Test
• Mood disorder evaluation
• DAPA drug and alcohol screen  

Evaluation Purpose:

• Evaluation of the respondent’s mental ability to practice chiropractic safely and skillfully.
• Evaluation of respondent’s reliability as a self-reporter.
• Evaluation of respondent’s amenability for treatment and prognosis of intervention.
• Evaluation of conditions, situations and issues that may interfere with or contribute to a more successful prognosis or successful completion of treatment.
• Recommendation with regard to community supervision and clinical management. 

Cognitive

Credentials:

• M.D., D.O., Ph.D., or Psy.D. with demonstrated certification, training and experience to administer tests listed under evaluation components.  

Evaluation Components:

• Webster Adult Intelligence scale
• Wechsler Memory Scale IV
• Halstead Category Test.
• Trail Marking Test A & B
• California Verbal Learning Test-2
• Minnesota Multiphasic Personality Inventory II
• Personality Assessment Inventory
• Behavioral observation and mental status exam  

Evaluation Purpose:

• Evaluation of the respondent’s mental ability to practice chiropractic safely and skillfully.
• Evaluation of respondent’s cognitive and intellectual functioning.
• Evaluation of respondent’s personality and emotional functioning.
• Evaluation of respondent’s amenability for treatment and prognosis of intervention.
• Evaluation of conditions, situations and issues that may interfere with or contribute to a more successful prognosis or successful completion of treatment.
• Recommendation with regard to community supervision and clinical management.