Perfusionist Licensure

Attention Applicant

Pursuant to NRS 630.167, as part of the application process, you are required to submit to a criminal background investigation. Upon receipt of your completed application, your License Specialist will send you an authorization form, the appropriate fingerprint cards, and instructions.

Forms

Perfusionist Application for Licensure

Use this link to apply online for licensure as a Perfusionist in the state of Nevada.

Application Checklist - Perfusionist Application

Form 1 - Perfusionist Application

Education Verification

Form 2 - Perfusionist Application

ABCP Certification

Form 3 - Perfusionist Application

Verification of State Licensure/Certification

Form 4 - Perfusionist Application

Malpractice Claim Verification

Form 5 - Perfusionist Application

Hospital Privileges Verification

Form A - Perfusionist Application

Release

Form B - Perfusionist Application

List of Malpractice Insurance Carriers

Form C - Perfusionist Application

Request for Licensure by Endorsement

Form C - Perfusionist Military Endorsement Application

Request for Licensure by Endorsement Via NAC 630.715

Civil Applicant Waiver - Perfusionist Application

Responsibility Statement - Perfusionist Application

Perfusionist Application - Military Endorsement

Use this form to apply for expedited license by endorsement to practice cardiovascular perfusion in the State of Nevada for U.S. Armed Forces active members, spouses of U.S. Armed Forces active members, veterans and spouses / surviving spouses of veterans. Please see Form C - Perfusionist Military Endorsement Application - here: Form C.

Perfusionist Application for License Reinstatement 2023-2025

Use this form to apply for reinstatement of your license.

Notification of Practice Location

Notification of Supervising Perfusionist - For Temporary Perfusionist Applications ONLY