Abdulaziz Khajafa

The Department of Health maintains all licensing for all medical services. The Medical Board shall be resposible for the issuance of licenses which is an independent body within the Department of Health. Please review the information contained in this section before proceeding.

Moderators: Executive Officers, DOH: State Medical Board

Post Reply
Abdulaziz_Khajafa
Posts: 1
Joined: April 25th, 2019, 7:04 pm

Abdulaziz Khajafa

Post by Abdulaziz_Khajafa » April 25th, 2019, 7:22 pm

divbox=white]
Image

STATE OF SAN ANDREAS
REQUEST FOR MEDICAL RECIPROCITY


  • SECTION ONE - PERSONAL INFORMATION

  • 1. TITLE: Dr.
    2. FULL NAME: Abdulaziz Khajafa
    3. DATE OF BIRTH: April 28th, 1979
    4. PLACE OF BIRTH: Baghdad, Iraq
    5. AGE AT TIME OF APPLICATION: 39

    6. PHONE NUMBER: 1592871
    7. E-MAIL ADDRESS: [email protected]
    8. DOMESTIC ADDRESS: 1222 Vinewood St, Los Santos, San Andreas, 7701

  • SECTION TWO - PERSONAL HISTORY

  • 9. HAVE YOU EVER GONE BY ANOTHER NAME? IF YES, LIST ALL THAT ARE APPLICABLE BELOW: N/A
    1. ANSWER
    10. HAVE YOU EVER BEEN CONVICTED OF BREACHING ANY OF THE SAN ANDREAS LAW OR THAT OF ANOTHER COUNTRY?: IF YES, EXPLAIN IN THOROUGH DETAIL: Yes
    1. ANSWER
    Parking fines, will pay them off soon.

    11. LIST ALL AND ANY EDUCATION THAT YOU HAVE ENROLLED IN. ADD MORE FIELDS IF NEEDED:
    • NAME OF HIGH SCHOOL: Baghdad All Boys Quranic School
      YEAR GRADUATED: 1997
      DEGREE(S) EARNED: High School Degree, Quran Expert Knowledge Certification

      NAME OF COLLEGE: Baghdad Medical University
      YEAR GRADUATED: 2004
      DEGREE(S) EARNED: Medicine Degree

      NAME OF MEDICAL SCHOOL: Chapel Hill School of Medicine
      YEAR GRADUATED: 2005

      TYPE OF MEDICAL DOCTOR: Medical Doctor, Addiction Specialist
      MCAT SCORE (COMPLEX-USA SCORE IF D.O): 528
      RESIDENCY LOCATION: Kernersville Veterans Affairs Hospital
      SPECIALIZATION: General Practice, Addiction Treatment.
      AFFILIATIONS AND OR BOARD CERTIFICATIONS: SAMHSA (Substance Abuse and Mental Health Services Administration) certified to prescribe Suboxone, Methadone and to provide counselling.

      12. LIST ALL AND ANY PREVIOUS EMPLOYMENT. ADD MORE FIELDS IF NEEDED:
      • NAME OF EMPLOYER: United States Veterans Affair Administration
        PLACE OF EMPLOYMENT: Kernersville Veterans Affair Hospital
        OFFICIAL COMPANY TITLE: Addiction Specialist
        JOB DESCRIPTION: Treated addiction to painkillers, benzodiazepines and illicit drugs with medication-assisted therapy and traditional therapy.
        DATE EMPLOYED: 2005
        DATE DISCHARGED: 2008
        REASON OF DISCHARGE: Moved to Los Santos.

    • SECTION THREE - LICENSING BASED QUESTIONS

    • 13. WHAT SORT OF PRACTICE/PROFESSION ARE YOU AIMING TO PURSUE IF LICENSED?:
      • [ ] NURSING
        [X] DOCTOR
      14. HAVE YOU EVER BEEN TRAINED IN BASIC LIFE SUPPORT AND/OR INTERMEDIATE LIFE SUPPORT?:
      • [ ] YES (WHO WAS THIS PROVIDED BY?: ANSWER)
        [X] NO
      15. PLEASE EXPLAIN IN FURTHER DETAIL WHY YOU WISH TO ACQUIRE A LICENSE TO PRACTICE MEDICINE:
      • Because Los Santos is ravaged by an Opioid Epidemic and I want to provide help through treating the underlying addictions in the city through traditional methods and medication-therapy. I also wish to help regular people through my General Practice license in getting on with their life even if they are sick or hurt. I am ready to help those in need in the city and I really mean that. This is an important thing for me.

    • SECTION FOUR - DECLARATION

    • I, Abdulaziz Khajafa, hereby declare that all of the information stated within this application is true and is as accurate to my knowledge as possible. I accept that, should I be found to have lied regarding any information, I am subject to immediate disciplinary action without question. I also affirm that I understand that, should my license be accepted, I am required to learn and follow acts up to and regarding the Hippocratic Oath. This declaration also serves as a confirmation that I have filled in all aforementioned details on my own and not by another.
      DATE: 04/25/2019
      SIGNATURE: Abdulaziz Khajafa
    [/divbox]

Post Reply