Forms and Publications

Forms

Consumers

Document Title
Consumer Complaint Form

Applicants

Document Title
Application for Psychiatric Technician Licensure by Examination
Application for Vocational Nurse Licensure by Endorsement
Application for Vocational Nurse Licensure by Examination
Authorization for Release of Confidential Information - (55P-6)
Authorization for Release of Confidential Medical Records and Information - (55P-5)
PT Employment Verification

Education

Document Title
Annual Report Form
Annual Report Faculty and Facilities Form
Approved Vocational Nursing Schools
Approved Psychiatric Technician Schools
Psychiatric Technician Blood Withdrawal Certification Course Providers
Psychiatric Technician Continuing Education Course Providers
Vocational Nurse Blood Withdrawal Certification Course Providers
Vocational Nurse Continuing Education Course Providers
Vocational Nurse IV Therapy Certification Course Providers
Vocational Nurse IV Therapy/Blood Withdrawal Certification Course Providers
Unapproved Nursing Programs

Licensees

Document Title
Address Change Request Form - (55P-4)
Application for Renewal
Employer Mandatory Reporting Form
Employment Verification - Nursing Experience - (55A-12)
Expert Witness Application
Fee Schedule
Licensee Mandatory Reporting Form
Name Change Request Form - (55P-3)
Notice on Collection of Personal Information For Applicants and Licensees

Enforcement

Document Title
How To File A Complaint

Publications

Document Title
Approved School Lists
Board Member Administrative Procedure Manual
Disciplinary Action Lists
Employer Mandatory Reporting
Fact Sheet (Out-of-State Applicants)
Licensed Vocational Nurse Fact Sheet
Licensee Mandatory Reporting
Strategic Plan

Brochures:

Document Title
Protecting California’s Healthcare Consumers