[Comment: Information regarding the availability
and effective date of the materials incorporated by reference in agency 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 electronically through the individual's eLicense account by
submitting a name change service request within thirty days of the change. The
request shall be accompanied by an uploaded 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) "Advanced Practice Registered
Nurse Application Certified Nurse Midwife," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(2) "Advanced
Practice Registered Nurse Application Certified Nurse Practitioner," dated
2021, may be obtained at http://www.nursing.ohio.gov/forms.htm;
(3) "Advanced
Practice Registered Nurse Application Certified Registered Nurse
Anesthetist," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(4) "Advanced
Practice Registered Nurse Application Clinical Nurse Specialist," dated
2021, may be obtained at http://www.nursing.ohio.gov/forms.htm;
(5) "Advanced Practice Registered
Nurse License Reactivation and Reinstatement Application," dated 2019, may
be obtained at http://www.nursing.ohio.gov/forms.htm;
(6) "Alternative Program for
Substance Use Disorder Admission Application," dated 2019, may be obtained
at http://www.nursing.ohio.gov/forms.htm;
(7) "Application for Initial
Approval/Reapproval of a Testing Organization that Conducts an Examination of
Dialysis Technicians," dated 2020, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(8) "Certified Registered Nurse
Anesthetist Renewal Application," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(9) "Certified Nurse Midwife Renewal
Application," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(10) "Certified Nurse Practitioner
Renewal Application," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(11) "Clinical Nurse Specialist
Renewal Application," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(12) "Community Health Worker
Application," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(13) "Community Health Worker
Reactivation and Reinstatement Application," dated 2019, may be obtained
at http://www.nursing.ohio.gov/forms.htm;
(14) "Community Health Worker Renewal
Application," dated 2019, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(15) "Community Health Worker
Training Program Approval Application," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(16) "Community Health Worker
Training Program Re-Approval Application," dated 2019, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(17) "Dialysis Technician
Application," dated 2019, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(18) "Dialysis Technician
Reactivation and Reinstatement Application," dated 2017, may obtained at
http://www.nursing.ohio.gov/forms.htm;
(19) "Dialysis Technician Renewal
Application," dated 2017, may obtained at
http://www.nursing.ohio.gov/forms.htm;
(20) "Dialysis Technician Training
Program Application for Initial Board Approval," dated 2018, may be
obtained at may obtained at http://www.nursing.ohio.gov/forms.htm;
(21) "Dialysis Technician Training
Program Re-Approval Application," dated 2018, may be obtained at may
obtained at http://www.nursing.ohio.gov/forms.htm;
(22) "Education Program PN Annual
Report Form," dated 2022, for licensed practical nursing education
programs, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(23) "Education Program RN Annual
Report Form," dated 2022, for registered nursing education programs, may
be obtained at http://www.nursing.ohio.gov/forms.htm;
(24) "Education Program PN Presurvey
Visit Report Form," dated 2017, for licensed practical nursing education
programs may be obtained at http://www.nursing.ohio.gov/forms.htm;
(25) "Education Program RN Presurvey
Visit Report Form," dated 2017, for registered nursing education programs,
may be obtained at http://www.nursing.ohio.gov/forms.htm;
(26) "LPN Reactivation and
Reinstatement Application," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(27) "LPN Renewal Application,"
dated 2020, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(28) "Medication Aide
Application," dated 2017, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(29) "Medication Aide Reactivation
and Reinstatement Application," dated 2016, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(30) "Medication Aide Renewal
Application," dated 2016, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(31) "Medication Aide Training
Program Application," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(32) "Medication Aide Training
Program Re-Approval Application," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(33) "Nursing Licensure by
Endorsement Application," dated 2016, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(34) "NEGP Annual Report Year
1," dated 2022, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(35) "NEGP Annual Report Year
2," dated 2022, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(36) "NEGP Quarterly Progress
Report," dated 2019, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(37) "NEGP RFP," dated 2021, may
be obtained at http://www.nursing.ohio.gov/forms.htm;
(38) "Nursing Licensure by
Endorsement Application, LPN" dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(39) "Nursing Licensure by
Endorsement Application, RN" dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(40) "Nursing Licensure by
Examination Application, LPN," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(41) "Nursing Licensure by
Examination Application, RN," dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(42) "OBN Approver Application,"
dated 2019, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(43) "PN New Program Proposal
Application," dated 2017, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(44) "RN New Education Program
Proposal Application," dated 2017, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(45) "RN Reactivation and
Reinstatement Application," dated 2016, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(46) "RN Renewal Application,"
dated 2021, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(47) "Verification Form Organizations
Certifying Advanced Practice Registered Nurses: Certified Nurse Midwives
(CNMs), Certified Nurse Practitioners (CNPs), Clinical Nurse Specialists
(CNSs), and Certified Registered Nurse Anesthetists (CRNAs)," dated 2020,
may be obtained at http://www.nursing.ohio.gov/forms.htm;
(48) "Volunteer's Certificate
Application," dated 2016, may be obtained at
http://www.nursing.ohio.gov/forms.htm;
(49) "Volunteer's Certificate
Reactivation and Reinstatement Application," dated 2016, may be obtained
at http://www.nursing.ohio.gov/forms.htm;
(50) "Volunteer's Certificate
Renewal Application," dated 2016, may be obtained at
http://www.nursing.ohio.gov/forms.htm.