Retired License

Retired Application Form   .pdf   -    .doc

    1. The fee of $50.00;
    2. His/her original wall license and all other evidence of licensure or a letter attesting to the board that the license has been lost, stolen, or destroyed;
    3. The completed Retired License Application Form available above and submit prior to the active license expiring on June 30 of the year of renewal.
    1. An Application for License Renewal (please see the appropriate tab for your license type);
    2. The reactivation fee of $100.00; and
    3. Satisfactory evidence of the completion of twenty (20) clock hours of board approved continuing education, as described in 19 CSR 73-2.050, for each calendar year the license was retired. All clock hours must be completed after the granting of the retired license or completed within the same licensure year the licensee was granted the retired license. The board may prorate the required clock hours for any portion of a calendar year as follows:
      1. Ten (10) months or more, but less than twelve (12) months-twenty (20) clock hours (including a minimum of five (5) patient care hours);
      2. Seven (7) months or more, but less than ten (10) months-fifteen (15) clock hours (including a minimum of five (5) patient care hours);
      3. Four (4) months or more, but less than seven (7) months-ten (10) clock hours (including a minimum of two and one-half (2.5) patient care hours); or
      4. Less than four (4) months-five (5) clock hours (including a minimum of two and one-half (2.5) patient care hours).

Retired Licensee Report