TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD OF NURSING
Forms
NOTICE: The following forms have been filed by the
Board of Nursing. The forms are available for public inspection at the Board of
Nursing, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, or at the
Office of the Registrar of Regulations, General Assembly Building, 2nd Floor,
Richmond, Virginia 23219. Copies of the forms may be obtained from Elaine
Yeatts, Agency Regulatory Coordinator, Department of Health Professions, 9960
Mayland Drive, Suite 300, Richmond, VA 23233-1463.
Titles of Regulations: 18VAC90-20. Regulations Governing
the Practice of Nursing.
18VAC90-25. Regulations Governing Certified Nurse Aides.
18VAC90-30. Regulations Governing the Licensure of Nurse
Practitioners.
18VAC90-40. Regulations for Prescriptive Authority for Nurse
Practitioners.
18VAC90-50. Regulations Governing the Certification of
Massage Therapists.
18VAC90-60. Regulations Governing the Registration of Medication Aides.
FORMS (18VAC90-20)
Application for Licensure by Endorsement -- Registered Nurse
(rev. 11/04) 1/08).
Instructions for Licensure by Endorsement -- Registered Nurse
(rev. 12/04) 1/08).
Instructions for Licensure by Endorsement -- Licensed
Practical Nurse (rev. 12/04) 1/08).
Application for Licensure by Endorsement -- Licensed
Practical Nurse (rev. 11/04) 1/08).
Instructions for Filing Application for Licensure by
Examination for Registered Nurses (rev. 12/04) 7/07).
Application for Licensure by Examination -- Registered Nurse
(rev. 12/04) 7/07).
Instructions for Filing Application for Licensure by
Examination for Practical Nurses (rev. 11/04) 7/07).
Application for Licensure by Examination -- Licensed
Practical Nurse (rev. 12/04) 7/07).
Instructions for Filing Application for Licensure by Repeat
Examination for Registered Nurses (rev. 6/04) 8/08).
Application for Licensure by Repeat Examination for
Registered Nurse (rev. 10/02) 7/07).
Instructions for Filing Application for Licensure by Repeat
Examination for Practical Nurses (rev. 2/03) 8/08).
Application for Licensure by Repeat Examination for Licensed
Practical Nurse (rev. 10/02) 7/07).
Instructions for Filing Application for Licensure by Examination
for Licensed Practical Nurses Educated in Other Countries (rev. 12/04) 7/07).
Application for Licensure by Examination for Licensed
Practical Nurses Educated in Other Countries (rev. 12/04) 7/07).
Instructions for Filing Application for Licensure by
Examination for Registered Nurses Educated in Other Countries (rev. 12/04)
7/07).
Application for Licensure by Examination for Registered
Nurses Educated in Other Countries (rev. 12/04) 7/07).
Temporary Exemption to Licensure (eff. 10/02) (rev.
7/07).
Instructions for Application for Reinstatement -- Registered
Nurse (eff. 12/04) (rev. 7/07).
Application for Reinstatement -- Registered Nurse (rev. 12/04)
7/07).
Instructions for Application for Reinstatement -- Licensed
Practical Nurse (eff. 12/04) (rev. 7/07).
Application for Reinstatement of License as a Licensed
Practical Nurse (rev. 12/04) 7/07).
Instructions for Application for Reinstatement Following
Suspension or Revocation -- Registered Nurse (eff. 12/04) (rev. 7/07).
Application for Reinstatement of License as a Registered
Nurse Following Suspension or Revocation (rev. 12/04) 7/07).
Instructions for Application for Reinstatement Following
Suspension or Revocation -- Licensed Practical Nurse (eff. 12/04) (rev.
7/07).
Application for Reinstatement of License as a Licensed
Practical Nurse Following Suspension or Revocation (rev. 12/04) 7/07).
License Verification Form (rev. 10/02) 1/08).
Renewal Notice and Application, 0001, RN (rev. 11/03).
Renewal Notice and Application, 0002, LPN (rev. 11/03).
Renewal Notice and Application, 0015, Clinical Nurse
Specialist (rev. 12/02).
Application for Registration as a Clinical Nurse Specialist
(rev. 10/02) 7/07).
Procedure for Registration as a Clinical Nurse Specialist (rev 7/07).
Survey Visit Report (rev. 12/02) 7/07).
Annual Report for Registered Nursing Programs (rev.
12/02).
Annual Report for Practical Nursing Programs (rev. 12/02).
Application for Registration for Volunteer Practice (eff.
12/02) (rev. 7/07).
Sponsor Certification for Volunteer Registration (eff.
1/03) (rev. 8/08).
FORMS (18VAC90-25)
Instructions for Application for Nurse Aide Certification by
Endorsement (rev. 1/06 8/07).
Application for Nurse Aide Certification by Endorsement (rev.
8/06 8/07).
Nurse Aide Certification Verification Form (rev. 12/02
11/07).
Instructions for Applicant for Advanced Certified Nurse Aide
Registration (eff. 8/06 rev. 8/07).
Application for Certification as Advanced Certified Nurse
Aide (rev. 8/06 8/07).
Instructions for Application for Reinstatement of Nurse Aide
Certification (rev. 8/06 1/08).
Application for Reinstatement of Nurse Aide Certification
(rev. 8/06 1/08).
Instructions for Application for Reinstatement of Advanced
Nurse Aide Certification (eff. 2/03 rev. 8/07).
Application for Reinstatement of Advanced Nurse Aide
Certification (eff. 2/03 rev. 8/07).
Application to Establish Nurse Aide Education Program (rev. 12/02
8/07).
Application to Establish an Advanced Certification Nurse Aide
Education Program (eff. 12/02 rev. 8/07).
Nurse Aide Education Program Evaluation Report (rev. 11/02
8/07).
Nurse Aide Education Program-On-site Review Report (rev. 11/02
8/07).
Advanced Certification Nurse Aide Education Program Evaluation Report (rev. 8/08).
Advanced Certification Nurse Aide Education Program-On-site
Review Report (eff. 12/02 rev. 8/07).
Evaluation of On-Site Visitor (rev. 12/02).
Request for Statistical Information (rev. 12/02 6/08).
Renewal Notice (eff. 4/05).
Renewal Notice and Application, 1401, Certified Nurse Aide
(rev. 12/02).
Renewal Notice and Application, Advanced Certified Nurse
Aide (eff. 12/02).
FORMS (18VAC90-30)
Instructions for Licensure -- Nurse Practitioner (rev. 10/02
1/08).
Application for Licensure as a Nurse Practitioner (rev. 10/02
1/08).
Renewal Notice and Application, Nurse Practitioner, 0024
(rev. 1/03).
Application for Reinstatement of License as a Nurse
Practitioner (eff. 10/02 rev. 7/07).
License Verification Form (rev. 7/07).
FORMS (18VAC90-40)
Application for Prescriptive Authority for Licensed Nurse
Practitioners (rev. 10/02 7/07).
Prescriptive Authority for Licensed Nurse Practitioners
Practice Agreement (rev. 10/02 7/07).
License Renewal Notice and Application (rev. 2002).
Application for Reinstatement of Prescriptive Authority (rev. 7/07).
FORMS (18 VAC 90-50)
Instructions for Filing Application for Certification as a
Massage Therapist (rev. 10/02 7/07).
Application for Certification -- Massage Therapist (rev. 10/02
7/07).
Instructions for Filing Application for Certification as a
Massage Therapist by Endorsement (rev. 10/02 7/07).
Application for Certification by Endorsement -- Massage
Therapist (rev. 10/02 7/07).
Massage Therapist Certification/Licensure Verification Form
(rev. 10/02 7/07).
Application for Reinstatement of Certificate as a Massage
Therapist (rev. 10/02 7/07).
Renewal Notice and Application (rev. 6/02).
Instructions for Application for Reinstatement following Suspension or Revocation – Certified Massage Therapist (rev. 7/07).
Application for Reinstatement of Certificate as a Massage Therapist following Suspension or Revocation (rev. 7/07).
FORMS (18VAC90-60)
Application to Establish a Medication Aide Training Program (eff. 7/07).
Instructions for Filing Application for Registration by Examination for Medication Aides (eff. 7/07).
Application for Registration by Examination for Medication Aide (eff. 7/07).
Instructions for Filing Application for Reinstatement as a Medication Aide (eff. 7/07).
Application for Reinstatement of Medication Aide Registration (eff. 7/07).
Application for Registration by Repeat Examination for Medication Aide (eff. 8/08).
VA.R. Doc. No. R09-1563; Filed August 27, 2008, 12:00 p.m.