Rule 4723-1-03 | Board records and documents.
[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.
Last updated February 1, 2024 at 9:29 AM
Supplemental Information
Amplifies: 4723.06
Five Year Review Date: 10/15/2027
Prior Effective Dates: 1/1/1967, 1/1/1971, 8/1/1983, 4/1/1991, 4/1/1993, 12/1/1993, 4/1/1994, 6/1/1995, 4/1/1997, 4/1/1998, 10/1/2000, 2/1/2003, 2/1/2004, 2/1/2008, 2/1/2010, 2/1/2013, 2/1/2016, 4/1/2017, 1/1/2018, 11/5/2018, 2/1/2020, 2/1/2021, 2/1/2022, 2/1/2023