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

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD OF NURSING
Chapter 19
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: 18VAC90-19. Regulations Governing the Practice of Nursing.

Effective Date: February 15, 2021.

Agency Contact: Elaine Yeatts, Agency Regulatory Coordinator, Department of Health Professions, 9960 Mayland Drive, Henrico, VA 23233, telephone (804) 367-4688, FAX (804) 527-4434, 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 (18VAC90-19)

Licensure by examination:

Instructions and Application for Licensure by Examination for Registered Nurses (rev. 8/2011)

Instructions and Application for Licensure by Examination -- Licensed Practical Nurse (rev. 8/2011)

Instructions and Application for Licensure by Repeat Examination for Registered Nurse (rev.12/2014)

Instructions and Application for Licensure by Repeat Examination for Licensed Practical Nurse (rev.12/2014)

License by endorsement:

Application for Licensure by Endorsement -- Registered Nurse (rev. 5/2011)

Instructions for Licensure by Endorsement -- Registered Nurse (rev. 5/2011)

Instructions for Licensure by Endorsement -- Licensed Practical Nurse (rev. 5/2011)

Application for Licensure by Endorsement -- Licensed Practical Nurse (rev. 6/2011)

Verification of Clinical Practice -- Licensure by Endorsement (rev. 1/2010)

Reinstatement:

Instructions and Application for Reinstatement -- Registered Nurse or Licensed Practical Nurse (rev. 10/2016)

Instructions and Application for Reinstatement of License as a Registered Nurse Following Suspension or Revocation (rev. 6/2011)

Instructions and Application for Reinstatement of License as a Licensed Practical Nurse Following Suspension or Revocation (rev. 6/2011)

Clinical nurse specialist:

Procedure (rev. 3/10) and Application for Registration as a Clinical Nurse Specialist (rev. 6/2011)

Instructions and Application for Reinstatement of Registration as a Clinical Nurse Specialist (rev. 3/2014)

Other:

Declaration of Primary State of Residency for Purposes of the Nurse Licensure Compact (rev. 7/2015)

License Verification Form (rev. 7/2016)

Application for Registration for Volunteer Practice (undated, filed 12/2016)

Sponsor Certification for Volunteer Registration (rev. 8/2008)

Verification of Supervised Clinical Practice -- Registered Nurse Provisional License (eff. 8/013)

Notification of Intent to Supervise Clinical Practice -- Registered Nurse Provisional License (rev. 4/2015)

Instructions and Application for Restricted Volunteer Nursing License (rev. 5/2016)

Request to Change License Status: Inactive to Active for RN and LPN (rev. 8/2016)

Registered Nurse - Licensure by examination:

Application for initial licensure as a registered nurse by examination available online at https://www.dhp.virginia.gov/Boards/Nursing/PractitionerResources/Forms/

Checklist Instructions Examination Application (rev. 6/2020)

Checklist Instructions Repeat Examination Application (rev. 11/2019)

Registered Nurse - License by endorsement:

Application for initial licensure as a registered nurse by endorsement available online at https://www.dhp.virginia.gov/Boards/Nursing/PractitionerResources/Forms/

Checklist Instructions Endorsement Application (rev. 3/2020)

Registered Nurse - Reinstatement:

Application for reinstatement of licensure as a registered nurse available online at https://www.dhp.virginia.gov/Boards/Nursing/PractitionerResources/Forms/

Checklist Instructions Reinstatement Application (rev. 8/2018)

Checklist Instructions for Reinstatement Application Following Suspension or Revocation (rev. 5/2018)

Request to Change License Status: Inactive to Active for RN & LPN (rev. 7/2019)

Clinical nurse specialist:

Application for registration or reinstatement as a clinical nurse specialist, available online at https://www.dhp.virginia.gov/Boards/Nursing/PractitionerResources/Forms/

Checklist Instructions for Reinstatement Application: Clinical Nurse Specialist Registration (rev. 5/2018)

Other:

Declaration of Primary State of Residence Form Under the Nurse Licensure Compact (rev. 4/2020)

Instructions for Registration for Volunteer Nursing Practice (rev. 8/2018)

Checklist Instructions Application for Restricted Volunteer License (rev. 8/2018)

VA.R. Doc. No. R21-6660; Filed January 24, 2021