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General Information
Complaint Forms
Complaint Form (for Email Submission)
(PDF) Version (for FAX or Postal Submission)
Supplemental Information Form for Employers (for Email Submission)
(PDF) Version (for FAX or Postal Submission)
Nursing Education Program Dissatisfaction Form
Medication Aides (Top of Page)
*NEW* Information Regarding Criminal Records Checks
Medication Aide Application
Form A
Supplemental Information Form
Community Health Workers (Top of Page)
If you are mailing one of the forms below to the Board of Nursing, please write on your envelope, along with the address, ATTENTION: COMMUNITY HEALTH WORKER UNIT. This will help facilitate processing your request.
*NEW* Information Regarding Criminal Records Checks
Community Health Worker Application
Form A
Supplemental Information Form
Dialysis Technicians (Top of Page)
If you are mailing one of the forms below to the Board of Nursing, please write on your envelope, along with the address, ATTENTION: DIALYSIS UNIT. This will help facilitate processing your request.
*NEW* Information Regarding Criminal Records Checks
Dialysis Technician
Application Instructions
Dialysis
Technician Application
Form A
Form B
Form C
Form D
Registry
Notice of Enrollee in a DT Program
Supplemental Information Form
Nurse License Renewal (Top of Page)
If you are mailing one of the forms below to the Board of Nursing, please write on your envelope, along with the address, ATTENTION: RENEWAL UNIT. This will help facilitate processing your request.
Changing Your Address: Print this Name and Address Change Form below, fill it out completely, and either mail or fax it to the address/fax number found on the form. If there is no change in name, you may also e-mail all of the required information to renewal@nursing.ohio.gov. If your name has changed, the form must be mailed to the Board along with an official, certified copy of the legal document changing your name.
Name/Address
Change Form
Affidavit of Lost Document
Restoration of Nursing License - (Request for Reinstatement / Reactivation)
Restoration of Nursing License - (Supplemental Disclosure Form)
Nurse Licensure by Examination and Endorsement (Top of Page)
Important Applicant Information - Please Read
PROCESSING TIME: The average
processing time is 30-35 business days, from the date your application is
received by the Board. This involves an initial review of the application,
data entry into the Board’s database, and processing of your application
fee. Once the initial review and processing of your application is complete,
Board staff determine whether other application documents have been
received (i.e. program completion letters, transcripts, license verifications,
background check reports).
CHECKING YOUR STATUS: To determine if your application has been received and reviewed, please
go to the Board web site at www.nursing.ohio.gov and click on “verification”. You will be redirected to the licensure verification web site
used by the Board. If your application has been entered into the Board’s
database, your name will appear in the list displayed. Once your name
appears, it will display as “pending” until your license is issued.If it has been more than 35 business days since the Board received your
application, and your name does not appear on the licensure verification
page, or you have not received your ATT, please contact the Licensure
Unit at (614) 995-7675 or by e-mail at licensure@nursing.ohio.gov. If it
has been less than 35 business days, please do not contact the Board as
there will not be any additional information that we can provide, and this
causes a further delay in processing applications. Currently the Board is receiving several hundred calls and e-mails daily
about the status of licenses, so your call or e-mail may not be returned
immediately. We have seen an increase in licensure volume over the last
several years and remain committed to issuing licenses as quickly as
possible. We appreciate your patience.
PAYMENT: Fees must be payable to “Treasurer, State of Ohio” and must accompany this application. Personal checks will not be accepted. Send a certified check, cashier’s check or money order. Business checks from government entities and education or training programs will be accepted. Payments must be drawn on a United States (U.S.) bank or payable in U.S. dollars. Please do not staple your payment to the application.
ALL APPLICANTS: If you are mailing one of the forms below to the Board of Nursing, please send to ATTENTION: LICENSURE UNIT. This will facilitate the processing of your request. Please refer to the NEW background check instructions that are attached to the on-line examination and endorsement applications.
EXAMINATION APPLICANTS: You may request a copy of the NCLEX Bulletin by contacting Pearson VUE at 1-866-496-2539 or on-line at www.vue.com/nclex.
ENDORSEMENT APPLICANTS: Complete Form B (enclosed) for verification of original licensure and/or current, valid licensure in good standing in
another jurisdiction. If you hold a license in a NURSYS State, you must request a verification on-line at www.nursys.com. If you do not know if your state is part of the NURSYS system, you can view this information on this web site.
CRIMINAL RECORD CHECKS: Click Here For More Information
We appreciate your patience.
Advanced Practice Nursing (Top of Page)
If you are mailing one of
the forms below to the Board of Nursing, please write on your
envelope, along with the address, ATTENTION: ADVANCED PRACTICE
UNIT. This will help facilitate processing your request.
Fees must be payable to “Treasurer, State of Ohio” and must accompany this application. Personal checks will not be accepted. Send a certified check, cashier’s check or money order. Business checks from government entities and education or training programs will be accepted. Payments must be drawn on a United States (U.S.) bank or payable in U.S. dollars. Please do not staple your payment to the application.
Prescriptive Authority Forms
Prescriptive Authority
Application Cover Letter
Prescriptive Authority
Instructions
Externship Instructions
Prescriptive Authority
Application
Form E
Form G
Certificate of Authority Forms
Certificate of Authority
Application Instructions
Certificate of Authority
Application
Form A
Form B
Alternative Program for Chemical Dependency (Top of Page)
Form F - Current Employer List
Form G - Treating Healthcare Practitioner List
Form I - Personal Report
Form K - Probation Report
Form L - Work Performance Evaluation
Form P - Mental Health Waiver
Form T -Provider List
Form V - Treatment Provider Waiver
Form W - Treatment Progress Evaluation
Form X - Healthcare Provider Evaluation
Form Z - Participant Treatment Plan
Compliance Program Post-Disciplinary Monitoring (Top of Page)
FirstLab Enrollment Packet and FAQs
Form 1 - Employer Report
Form 4 - Meeting Documentation
Form 5 - Medication Report
Form 6 - Medical Report
Form 7 - Prescription Medication Report
Form 9 - Mental Health Professional Report
Form 10 - Probation Report
Form 11 - Release of Information
Form 12 - Substance Abuse Treatment Program Report (Aftercare)
Form 13 - Substance Abuse Treatment Program Report
Form 14 - Treating Healthcare Practitioner List
