TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF MEDICINE

Forms

Titles of Regulations: 18VAC85-80. Regulations Governing the Practice of Occupational Therapy.

18VAC85-110. Regulations Governing the Practice of Licensed Acupuncturists.

18VAC85-120. Regulations Governing the Licensure of Athletic Trainers.

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

18VAC85-160. Regulations Governing the Licensure of Surgical Assistants and Certification of Surgical Technologists.

Agency Contact: Erin Barrett, Director of Legislative and Regulatory Affairs, Department of Health Professions, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 750-3912, or email erin.barrett@dhp.virginia.gov.

FORMS (18VAC85-80)

Instructions for Completing an Application to Practice as an Occupational Therapist/Occupational Therapy Assistant in Virginia (rev. 12/2017)

Instructions and Application for Reinstatement of a License to Practice as an Occupational Therapist/Occupational Therapy Assistant (rev. 4/2018)

Application to Reactivate an Occupational Therapist Assistant License from Inactive Status (rev. 3/2024)

Application to Reactivate an Inactive License for an Occupational Therapist Pursuant to Virginia Regulations 18VAC85-80-72 (rev. 1/2018)

Application to Reactivate a License from Inactive Status for Occupational Therapists and Occupational Therapy Assistants (rev. 8/2025)

Board-Approved Occupational Therapy Practice to Reinstate an Inactive License (rev. 3/2024)

Supervised Occupational Therapy Services (lapse six years or more) (rev. 5/2017)

Continued Competency Activity and Assessment Form (rev. 4/2000)

Application for Restricted Volunteer License (rev. 8/2015)

Application for Registration for Volunteer Practice (rev. 7/2025)

Sponsor Certification for Volunteer Registration (rev. 3/2018)

License Verification Request (rev. 2/2024)

FORMS (18VAC85-110)

Instructions for Completing an Application to Practice as an Acupuncturist in Virginia (rev. 3/2017)

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

Form C, Clearance from Other State Boards (rev. 11/2010)

Form L, Certificate of Professional Education (rev. 8/2007)

Verification of NCCAOM Certification (rev. 3/2008)

Recommendation for Examination by a Physician (rev. 11/2006)

License Verification Request (rev. 2/2024)

Application for Registration for Volunteer Practice (rev. 7/2025)

Sponsor Certification for Volunteer Registration (rev. 3/2018)

Instructions and Application for Reinstatement of an Acupuncture Licensure (rev. 4/2018)

Application to Reactivate an Inactive License for a Licensed Acupuncturist (rev. 1/2018)

Application to Reactivate an Inactive License for a Licensed Acupuncturist (rev. 8/2025)

FORMS (18VAC85-120)

Instructions for Completing an Athletic Trainer Licensure Application (12/2017)

Application for Registration for Volunteer Practice without fee (rev. 7/2025)

Sponsor Certification for Volunteer Registration (rev. 3/2018)

Instructions and Application for Reinstatement of an Athletic Trainer Licensure (rev. 4/2018)

Certificate of Professional Education (rev. 8/2007)

License Verification Request (rev. 2/2024)

Application to Reactivate an Athletic Trainer License from Inactive Status (rev. 8/2025)

FORMS (18VAC85-130)

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

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

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)

Application to Reactivate an Inactive License for a Licensed Midwife (rev. 8/2025)

License Verification Request (rev. 2/2024)

FORMS (18VAC85-160)

Instructions for Completing an Application to Practice as a Licensed Surgical Assistant (rev. 10/2020)

Instructions for Completing an Application to Practice as a Certified Surgical Technologist (rev. 5/2022)

License Verification Request (rev. 2/2024)

Application for Reactivation for a Licensed Surgical Assistant or Certified Surgical Technologist from Inactive Status (rev. 8/2025)