Beginning July 1, 2006, all perfusionists in North Carolina must obtain licensure in order to practice perfusion. There are three pathways by which a person may obtain his or her perfusion license. They are: Regular Pathway, Reciprocity Pathway, or Provisional Pathway.
Regular Pathway: This pathway is for applicants who have graduated from an approved educational program, have a current certification as a clinical perfusionist, and who do not wish, or may not be qualified, to obtain a license by one of the other pathways.
Reciprocity Pathway: This pathway is available for applicants who are licensed, in good standing, as a perfusionist in another state or United States Territory, and who can satisfy one of the following two criteria:
1) The state or territory in which he or she is licensed has laws regulating perfusion that are substantially equivalent to the laws of North Carolina*; or
2) The applicant has current certification as a clinical perfusionist. * In the event the applicant seeks reciprocity by electing this criteria, the Perfusionist Advisory Committee of the North Carolina Medical Board (PAC) will obtain the laws of the other state and make a determination as to whether such laws are substantially equivalent to those of North Carolina.
Provisional Pathway: This pathway is for applicants who do not have certification as a clinical perfusionist but do satisfy the educational requirements for perfusion licensure, and who do not qualify for licensure under the Reciprocity Pathway. A provisional license applicant must be supervised by a licensed perfusionist, and the provisional license may not exceed a period of twelve (12) months. The provisional license applicant must complete a Designation of Supervising Perfusionist Form.
Converting A Provisional License to a Full License
A provisional licensed perfusionist who receives certification from the American Board of Cardiovascular Perfusion (ABCP) may request that his or her provisional license be converted to a full license. The provisional licensee must submit a written request for the conversion and proof of certification from the ABCP, and pay the conversion fee. The Perfusionist Advisory Committee may request additional information or conduct an interview of the applicant to determine the applicant’s qualifications.
An application for license in North Carolina is a confidential matter therefore we are unable to respond to any questions regarding your application from anyone other than you, the applicant. The licensing department may be contacted by e-mail at email@example.com.
1. Completed application form (applies to all pathways)
- CIRCLE the correct answer for all questions.
- Provide DETAILED explanations for affirmative answers.
- A claim form must be completed for EACH malpractice suit or settlement (form enclosed-photocopy as needed). ATTACH A PHOTOCOPY OF PLAINTIFF’S COMPLAINTS AND SETTLEMENT ORDERS FOR EACH INCIDENT.
- Sign applicant’s oath and have signature NOTARIZED.
- Submit ORIGINAL Application Form to the Committee. Include name change documentation, if applicable.
2. Verification of Education (not required if applying under Reciprocity Pathway) Verification of education using the Education Certification Form. This certification must bear the original signature of the Dean or other Official of the program; their official title and the seal of the program/school.
3. ABCP Certification (applies to Regular pathway and Reciprocity pathway) Primary source verification of current certification from the American Board of Cardiovascular Perfusion (ABCP). (This verification is not required if applying under the Provisional Pathway. This verification may also be required under the Reciprocity Pathway—See Licensing Overview for further details) You may request verification by phone, fax, e-mail, or letter. An authorization for release of information is not necessary. They will respond directly to the Board. Original certification is required. Fax number: 601-582-2271 E-mail address: firstname.lastname@example.org Mailing address: ABCP, 207 North 25th Avenue, Hattiesburg, MS 39401
4. Verification of Other State License (applies to all pathways) Using the License Biography Form you must secure a report from each state in which you have ever been licensed as a perfusionist, regarding the status of that license. All licenses, active and/or inactive, must be verified. Most states charge a fee for this service.
The license application process involves the collection of credentials from you the applicant, and from other sources as well. Once all application materials have been collected, our staff must review them. After reviews have been done, it may be necessary for the staff to request additional information, and/or to return items that need corrections or clarifications. It is our goal to review materials as quickly as possible, but we must be thorough. You should expect the entire process to take several weeks from the time your application is received by the PAC. Please adhere to the following guidelines:
1. Beginning July 1, 2006, you may not practice as a perfusionist in North Carolina without a license.
2. There are some items that must be sent from the primary source. However, some agencies will not send credentials to the applicant. Credentials received prior to receiving your application will be held in our office for one year.
3. If you have been named in any malpractice suits, or have answered, “yes” to any of the questions on our application, anticipate the possibility that additional information will be requested and an interview may be required.
4. All application information is strictly confidential pursuant to state law. Therefore, we may only speak to the applicant about the application. Relatives, staff members, future employers or placement services cannot be informed about the status of your application.
5. You will be notified in writing regarding any deficiencies in your application once it has been reviewed.
6. Questions regarding your application can be e-mailed to email@example.com. Note: It is recommended that you keep a copy of application materials as we will be unable to return original or photocopied application materials once received.
Fee (applies to all pathways) A fee of $390.00U.S. dollars is to be paid at the time the application is submitted. ($350.00 for the license application fee, $2.00 for NPDB report, and $38.00 for the criminal background check fee). If you request a provisional license, a fee of $215.00 is required. ($175.00 for the provisional license application fee, $2.00 for the NPDB report, and $38.00 for the criminal background check fee). If you request an upgrade of your provisional license to a full license, a fee of $175 is required. Personal checks made payable to the NC Medical Board are acceptable. Checks returned for insufficient funds will require an additional $20.00 fee. Returned checks must be replaced by a certified check or money order. Fees received are not refundable. Applications will not be processed until the application fee has been received.