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REGULATIONS
Vol. 28 Iss. 10 - January 16, 2012TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSINGBOARD OF NURSINGChapter 40FormsREGISTRAR'S NOTICE: The following forms used in administering the regulations referenced below have been filed by the Board of Nursing. Amended or added forms are not being published, but online users of the Virginia Register of Regulations may view the forms by clicking on the title of the form. The forms are also available through the agency contact listed below or may be viewed at the Office of the Registrar of Regulations, General Assembly Building, 2nd Floor, Richmond, Virginia 23219.
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.
Agency Contact: Elaine J. Yeatts, Senior Policy Analyst, Virginia Department of Health Professions, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4688, FAX (804) 527-4434, or email elaine.yeatts@dhp.virginia.gov.
FORMS (18VAC90-20)
Application for Licensure by Endorsement -- Registered Nurse (rev. 1/08).Instructions for Licensure by Endorsement -- Registered Nurse (rev. 6/09).Instructions for Licensure by Endorsement -- Licensed Practical Nurse (rev. 6/09).Application for Licensure by Endorsement -- Licensed Practical Nurse (rev. 1/08).Instructions for Filing Application for Licensure by Examination for Registered Nurses (rev. 7/07).Application for Licensure by Examination -- Registered Nurse (rev. 7/07).Instructions for Filing Application for Licensure by Examination for Practical Nurses (rev. 7/07).Application for Licensure by Examination -- Licensed Practical Nurse (rev. 7/07).Instructions for Filing Application for Licensure by Repeat Examination for Registered Nurses (rev. 8/08).Application for Licensure by Repeat Examination for Registered Nurse (rev. 7/07).Instructions for Filing Application for Licensure by Repeat Examination for Practical Nurses (rev. 8/08).Application for Licensure by Repeat Examination for Licensed Practical Nurse (rev. 7/07).Instructions for Filing Application for Licensure by Examination for Licensed Practical Nurses Educated in Other Countries (rev. 7/07).Application for Licensure by Examination for Licensed Practical Nurses Educated in Other Countries (rev. 7/07).Instructions for Filing Application for Licensure by Examination for Registered Nurses Educated in Other Countries (rev. 7/07).Application for Licensure by Examination for Registered Nurses Educated in Other Countries (rev. 7/07).Temporary Exemption to Licensure (rev. 7/07).Instructions for Application for Reinstatement -- Registered Nurse (rev. 7/07).Application for Reinstatement -- Registered Nurse (rev. 7/07).Instructions for Application for Reinstatement -- Licensed Practical Nurse (rev. 7/07).Application for Reinstatement of License as a Licensed Practical Nurse (rev. 7/07).Instructions for Application for Reinstatement Following Suspension or Revocation -- Registered Nurse (rev. 7/07).Application for Reinstatement of License as a Registered Nurse Following Suspension or Revocation (rev. 7/07).Instructions for Application for Reinstatement Following Suspension or Revocation -- Licensed Practical Nurse (rev. 7/07).Application for Reinstatement of License as a Licensed Practical Nurse Following Suspension or Revocation (rev. 7/07).License Verification Form (rev. 1/08).Application for Registration as a Clinical Nurse Specialist (rev. 7/07).Procedure for Registration as a Clinical Nurse Specialist (rev. 7/07).Survey Visit Report (rev. 7/07).Application for Licensure by Endorsement -- Registered Nurse (rev. 5/11).
Instructions for Licensure by Endorsement -- Registered Nurse (rev. 5/11).
Instructions for Licensure by Endorsement -- Licensed Practical Nurse (rev. 5/11).
Application for Licensure by Endorsement -- Licensed Practical Nurse (rev. 6/11).
Verification of Clinical Practice -- Licensure by Endorsement (rev. 1/10).
Instructions and Application for Licensure by Examination for Registered Nurses (rev. 8/11).
Instructions and Application for Licensure by Examination -- Licensed Practical Nurse (rev. 8/11).
Instructions and Application for Licensure by Repeat Examination for Registered Nurse (rev. 8/11).
Declaration of Primary State of Residency for Purposes of the Nurse Licensure Compact (rev. 6/11).
Instructions for Application for Reinstatement -- Registered Nurse (rev. 1/10).
Application for Reinstatement -- Registered Nurse (rev. 6/11).
Instructions for Application for Reinstatement -- Licensed Practical Nurse (rev. 2/10).
Application for Reinstatement of License as a Licensed Practical Nurse (rev. 6/11).
License Verification Form (rev. 10/09).
Procedure (rev. 3/10) and Application for Registration as a Clinical Nurse Specialist (rev. 6/11).
Application for Reinstatement of Registration as a Clinical Nurse Specialist (rev. 6/11).
Application to Establish a Nursing Education Program (rev. 6/11).
Agenda and Survey Visit Report -- Registered Nurse Education Program (rev. 4/08).
Agenda and Survey Visit Report -- Practical Nurse Education Program (rev. 4/08).
NCLEX Survey Visit Report (rev. 4/08).
Application for Registration for Volunteer Practice (rev. 7/07).
Sponsor Certification for Volunteer Registration (rev. 8/08).
FORMS (18VAC90-25)
Instructions for Application for Nurse Aide Certification by Endorsement (rev. 8/07).Application for Nurse Aide Certification by Endorsement (rev. 8/07).Instructions for Application for Nurse Aide Certification by Endorsement (rev. 1/11)t
Application for Nurse Aide Certification by Endorsement (rev. 8/08).
Nurse Aide Certification Verification Form (rev. 11/07).
Instructions for Applicant for Advanced Certified Nurse Aide Registration (rev. 8/07).Application for Certification as Advanced Certified Nurse Aide (rev. 8/07).Instructions for Application for Reinstatement of Nurse Aide Certification (rev. 1/08).Application for Reinstatement of Nurse Aide Certification (rev. 1/08).Instructions for Application for Reinstatement of Advanced Nurse Aide Certification (rev. 8/07).Application for Reinstatement of Advanced Nurse Aide Certification (rev. 8/07).Application to Establish Nurse Aide Education Program (rev. 8/07).Instructions and Application for Certification as Advanced Certified Nurse Aide (rev. 8/07).
Instructions and Application for Reinstatement of Nurse Aide Certification (rev. 8/08).
Instructions and Application for Reinstatement of Advanced Nurse Aide Certification (rev. 8/07).
Application to Establish Nurse Aide Education Program (rev. 7/11).
Application to Establish an Advanced Certification Nurse Aide Education Program (rev. 8/07).
Nurse Aide Education Program Evaluation Report (rev. 8/07).
Nurse Aide Education Program-On-site Review Report (rev. 8/07).
Advanced Certification Nurse Aide Education Program Evaluation Report (rev. 8/08).
Advanced Certification Nurse Aide Education Program-On-site Review Report (rev. 8/07).
Request for Statistical Information (rev. 6/08).
FORMS (18VAC90-30)
Instructions for Licensure -- Nurse Practitioner (rev. 1/08).Application for Licensure as a Nurse Practitioner (rev. 1/08).Application for Reinstatement of License as a Nurse Practitioner (rev. 7/07).Instructions for Licensure -- Nurse Practitioner (rev. 2/09).
Application for Licensure as a Nurse Practitioner (rev. 6/11).
Application for Reinstatement of License as a Nurse Practitioner (rev. 6/11).
License Verification Form (rev. 7/07).
FORMS (18VAC90-40)
Application for Prescriptive Authority for Licensed Nurse Practitioners (rev. 7/07).Prescriptive Authority for Licensed Nurse Practitioners Practice Agreement (rev. 7/07).Application for Prescriptive Authority for Licensed Nurse Practitioners (rev. 6/11).
Prescriptive Authority for Licensed Nurse Practitioners Practice Agreement (rev. 3/11).
Application for Reinstatement of Prescriptive Authority (rev. 7/07).
FORMS (18VAC90-50)
Instructions for Filing Application for Certification as a Massage Therapist (rev. 7/07).Application for Certification -- Massage Therapist (rev. 7/07).Instructions for Filing Application for Certification as a Massage Therapist by Endorsement (rev. 7/07).Application for Certification by Endorsement -- Massage Therapist (rev. 7/07).Instructions and Application for Certification as a Massage Therapist (rev. 6/11).
Instructions and Application for Certification by Endorsement -- Massage Therapist (rev. 6/11).
Massage Therapist Certification/Licensure Verification Form (rev. 7/07).
Application for Reinstatement of Certificate as a Massage Therapist (rev. 7/07).Application for Reinstatement of Certificate as a Massage Therapist (rev. 6/11).
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).
Application for Registration by Examination for Medication Aide (eff. 7/07).Instructions for Filing Application for Reinstatement as a Medication Aide (eff. 7/07).Instructions for Filing Application for Reinstatement as a Medication Aide (rev. 7/11).
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. R12-3068; Filed December 16, 2011, 11:35 a.m.
