REGULATIONS
Vol. 37 Iss. 13 - February 15, 2021

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD OF MEDICINE
Chapter 130
Forms

REGISTRAR'S NOTICE: Forms used in administering the regulation have been filed by the agency. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form with a hyperlink to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, 900 East Main Street, 11th Floor, Richmond, Virginia 23219.

Title of Regulation: 18VAC85-130. Regulations Governing the Practice of Licensed Midwives.

Effective Date: February 15, 2021.

Agency Contact: Elaine J. Yeatts, Agency Regulatory Coordinator, Name of Board, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4688, or email elaine.yeatts@dhp.virginia.gov

Summary of Public Comments and Agency's Response: No public comments were received by the promulgating agency.

FORMS (18VAC85-130)

Instructions for and Application to Practice as a Licensed Midwife (rev. 11/10).

Instructions for Completing a Licensed Midwife Application (rev. 3/2017)

Form A, Claims History (rev. 11/2010)

Form B, Activity Questionnaire (rev. 11/10).

Form B, Activity Questionnaire (rev. 7/2017)

Form B Supplemental Form (rev. 9/2018)

Form C, Jurisdiction Clearance (rev. 11/2010)

Instructions and Application for Reinstatement of a License to Practice as a Certified Professional Midwife (CPM) (rev. 4/2018)

Application to Reactivate an Inactive License for a Licensed Midwife (rev. 5/2019)

VA.R. Doc. No. R21-6638; Filed January 24, 2021