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LSBN Forms

Educational

Faculty Exception Form

Nurse Faculty Qualification Form

Clinical Facility Survey

Preceptor Qualifications Form

Annual Report for Undergraduate Programs

Annual Report for Graduate Programs

Examination

Instructions for Initial Licensure by Examination

Application for Initial Licensure by Examination

Examination Fingerprint Card Request Form

Request for Retake of NCLEX

Licensure Exam Fingerprint Instructions and Authorization Sheet for Criminal Background Check

Prescriptive Authority

Instructions and Application for Initial Prescriptive Authority in the State of Louisiana

Instructions and Forms for Requesting a Change of Prescriptive Authority Privileges

Instructions and Forms for Adding Controlled Substances to Prescriptive Authority Privileges

Collaborative Practice Agreement (CPA) template form

RNP

Calendar Report

Medication Report

Treatment Centers Approved by the Louisiana State Board of Nursing

In-Patient Evaluation Centers Approved by the Louisiana State Board of Nursing

Out-Patient Evaluation Centers Approved by the Louisiana State Board of Nursing

Therapist Report

Aftercare Reporting Form

Psychiatrist Report

Misc. Forms

Name Change Request Form

Address Change Form

Order Form for Data Services

Petition for a Declaratory Statement

Verification of Renewal Requirements for APRN's without National Certification (Commensurate) (Form #VR-1)

Medication Report Form For Non RNP Participants

Fingerprint Instructions and Authorization Sheet for Criminial Background Check

Disaster Permit Affidavit

Reinstatement

RN Reinstatement Packet

APRN Reinstatement Packet

Endorsement

Instructions and Application forms for Initial RN License by Endorsement

CE Audit

CE Audit Form # 1 – Audit Verification Checklist

CE Audit Form # 2- Nursing Employment Verification

PA Audit Form #1 - CE Audit Verification Checklist – Prescriptive Authority

Advanced Practice Registered Nurses

Advanced National Certifying Organizations

Instructions and Application for Initial APRN Licensure by Examination

Instructions and Application for APRN Licensure by Endorsement

Instructions and Application to Request APRN Licensure in an Additional AP Role and Population Focus/Specialty