A. An applicant shall complete and submit to the Board a Board-approved written attestation that:
(1) States that the applicant has a collaboration and consultation agreement with a physician licensed in this State under Health Occupations Article, Title 14, Annotated Code of Maryland;
(2) Includes the name and license number of the physician with whom the applicant has a collaboration and consultation agreement;
(3) States that the applicant will require patients to sign a consent form in plain language that:
(a) The naturopathic doctor’s practice of naturopathic medicine is limited to the scope of practice identified in Health Occupations Article, §14-5F-14, Annotated Code of Maryland; and
(b) Describes the differences in scope of practice between naturopathic doctors and physicians;
(4) States that naturopathic doctors shall refer patients to and consult with physicians and other health care providers licensed or certified under the Health Occupations Article as needed; and
(5) In cases where the naturopathic doctor diagnoses a patient with a life threatening condition, states that the naturopathic doctor shall:
(a) Counsel and discuss with the patient the potential benefits offered by other physicians or other healthcare professionals; and
(b) Attempt to make the appropriate referral.
B. An applicant shall inform the physician named as a collaborating physician in the attestation that the physician has been named.