Licensing Requirements

Applicants must list all states where they do or did hold credentials. This list must also include when the applicant has applied for a credential, even if a credential was not granted. The jurisdiction where the applicant is or was credentialed must complete and submit the verification form (PDF). The jurisdiction must send the completed form directly to the department.

Each applicant must answer the personal data questions. If there is a positive answer to the professional liability claims history question, the applicant must send an explanation of the nature of the case, data and summary of care given, copies of the original complaint, and the settlement or final disposition. If the case is pending, applicant must indicate status.