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
https://nsbme.us.thentiacloud.net/webs/nsbme/application/#/login
Use this link to apply online for licensure as a Perfusionist in the state of Nevada.
/uploadedFiles/mednvgov/content/Licensees/Form_1_Perfusionist_Application.pdf
Education Verification
/uploadedFiles/mednvgov/content/Licensees/Form_2_Perfusionist_Application.pdf
ABCP Certification
/uploadedFiles/mednvgov/content/Licensees/Form_3_Perfusionist_Application.pdf
Verification of State Licensure/Certification
/uploadedFiles/mednvgov/content/Licensees/Form_4_Perfusionist_Application.pdf
Malpractice Claim Verification
/uploadedFiles/mednvgov/content/Licensees/Form_A_Perfusionist_Application.pdf
Release
/uploadedFiles/mednvgov/content/Licensees/Form_B_Perfusionist_Application.pdf
List of Malpractice Insurance Carriers
/uploadedFiles/mednvgov/content/Licensees/Form_C_Perfusionist_Application.pdf
Request for Licensure by Endorsement
/uploadedFiles/mednvgov/content/Licensees/Civil_Applicant_Waiver_Perfusionist_Application.pdf
/uploadedFiles/mednvgov/content/Licensees/Responsibility Statement.pdf
/uploadedFiles/mednvgov/content/Licensees/Perfusionist Reinstatement 2019-2021.pdf
To apply for reinstatement as an Perfusionist in the state of Nevada, download this printable form (pdf), which includes detailed instructions.