Forms & Fees


Application for License/Registration/Permit - Online Licensing Database & Services
To make application for a license, registration or permit, please visit the Board's online licensing database.   After logging in to your personal account, you may make application for a new license or renewal, submit a change of address, and make a number of other requests online. Payment may be made by credit card, or check/money order.  The online shop also allows you to purchase and request a number of items online.

Please be aware of the following:

  • Applications submitted on paper may take 4-6 weeks longer to process than applications submitted electronically through the online licensing database.             
  • Applications and other requests are not considered complete until the appropriate fee(s) have been received. 
  • In order for CPR certification to be accepted for the purposes of initial application and renewal, the CPR course must be a nationally-recognized course that includes a clinical, "hands-on" portion. Online-only certification courses are not acceptable pursuant to Iowa Administrative Code 650.

Fee Schedule
For information about the fees charged for applications, renewals, reinstatements, verifications and other services follow this link.


Forms

Approved Testing Sites PDF
Change of Address/Name Online
Complaint Form PDF
Complaint Form Online
Order Form - Purchase a Data List or Mailing List PDF
Order Form - Trainee Manual, certificates, cards, written certification, printed copies of Board rules and Iowa Code PDF
Public Health Supervision Forms Online
Sample Lab Prescription and Point of Origin Form PDF
Sign Up for Board Notices via E-Mail Online
Website Feedback Form Online
Infection Control Inspection Form PDF
IPRC Self-Report Form PDF
Malpractice Report Form PDF

Continuing Education Forms

Approved Sponsor List Online
Prior Approval of a Continuing Education Course PDF
Post Approval of a Continuing Education Course PDF
Prior Approval for Expanded Function Training PDF
Sample Expanded Functions Documentation Form - DA PDF
Sample Expanded Functions Documentation Form - RDH PDF
Sample Continuing Education Record PDF
Sample Continuing Education Record Word
Continuing Education Sponsor Application PDF
Sample Attendance Record Report PDF
Application for Exemption or Extension of Continuing Education Requirements PDF

Forms
Most of the forms above are in PDF and require Adobe Reader to view. If you do not have Adobe Reader, you can download that software at the Adobe website. Other forms are viewable in your web browser.   

Printed from the website on January 22, 2018 at 7:52am.