4723-1-03 Board records and documents.

[Comment: Information regarding the availability and effective date of the materials incorporated by reference in Chapter 4723. of the Administrative Code can be found in paragraph (G) of this rule.]

(A) The board shall maintain a record of all applicants for, and holders of, licenses and certificates issued by the board under Chapter 4723. of the Revised Code and any rules adopted under that chapter, in the format determined by the board.

(B) A change in name shall be submitted to the board on a "Name Change Form" within thirty days of the change and shall be accompanied by a certified copy of one of the following documents:

(1) A marriage certificate or abstract;

(2) A dissolution or divorce decree;

(3) A court record indicating a change of name; or

(4) Documentation of a change in name consistent with the laws of the jurisdiction or foreign country where the name change occurred.

(C) A notification of a change in address shall be submitted in writing or electronically, by the licensee or certificate holder to the board within thirty days of the change.

(D) Documents submitted to the board may be returned at the discretion of the board.

(E) Wall certificates or other documents issued by the board as evidence of licensure, certification, or other authorization to practice shall not be falsified or altered.

(F) For purposes of Chapters 4723-1 to 4723-27 of the Administrative Code, when an applicant for licensure or certification, or renewal, reactivation or reinstatement of licensure or certification, submits a criminal records check completed by the bureau of criminal identification and investigation, the board shall consider the records check information to be valid for a period of one year from the date the information was received by the board. This provision shall not apply to criminal records checks required to be obtained according to the terms of board adjudication orders or consent agreements.

(G) Incorporated materials:

(1) "2016 Verification Form for Organizations Certifying Nurse Midwives (CNMs), Certified Nurse Practitioners (CNPs), Clinical Nurse Specialists (CNSs), and Certified Registered Nurse Anesthetists (CRNAs)," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(2) "Certificate of Authority (COA-NA) Renewal Application," dated 2015, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(3) "Certificate of Authority (COA-NP) Renewal Application," dated 2015, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(4) "Certificate of Authority (COA-NS) Renewal Application," dated 2015, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(5) "Certificate of Authority (COA-NM) Renewal Application," dated 2015, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(6) "Certificate of Authority (COA) Reactivation and Reinstatement Application,"dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(7) "Certificate to Prescribe (CTP) Reactivation and Reinstatement Application,"dated 2016 may be obtained at http://www.nursing.ohio.gov/forms.htm;

(8) "Education Program PN Annual Report Form," dated 2016, for licensed practical nursing education programs, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(9) "Education Program RN Annual Report Form," dated 2016, for registered nursing education programs, may be obtained athttp://www.nursing.ohio.gov/forms.htm;

(10) "Education Program PN Presurvey Visit Report Form," dated 2014, for licensed practical nursing education programs may be obtained at http://www.nursing.ohio.gov/forms.htm;

(11) "Education Program RN Presurvey Visit Report Form," dated 2014, for registered nursing education programs, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(12) "LPN IV Therapy Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(13) "LPN Reactivation and Reinstatement Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(14) "LPN Renewal Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(15) "Medication Aide Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(16) "Medication Aide Reactivation and Reinstatement Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(17) "Medication Aide Renewal Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(18) "Medication Aide Training Program Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(19) "Medication Aide Training Program Re-Approval Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(20) "Name Change Form," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(21) "Nursing Licensure by Endorsement Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm

(22) "Nursing Licensure by Examination Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(23) "PN New Program Proposal Application," dated 2012, may be obtained athttp://www.nursing.ohio.gov/forms.htm;

(24) "RN New Education Program Proposal Application," dated 2012, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(25) "RN Reactivation and Reinstatement Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(26) "RN Renewal Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(27) "Request for Replacement Wall Certificate Form," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(28) "Volunteer's Certificate Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(29) "Volunteer's Certificate Reactivation and Reinstatement Application," dated 2016, may be obtained at http://www.nursing.ohio.gov/forms.htm;

(30) "Volunteer's Certificate Renewal Application," dated 2016, may be obtained athttp://www.nursing.ohio.gov/forms.htm.

Effective: 4/1/2017
Five Year Review (FYR) Dates: 10/15/2017
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.06
Prior Effective Dates: 1/1/67, 1/1/71, 8/1/83, 4/1/91, 4/1/93, 12/1/93, 4/1/94, 6/1/95, 4/1/97, 4/1/98, 10/1/00, 2/1/03, 2/1/04, 2/1/08, 2/1/10, 2/1/13, 2/1/16