As part of an online application, the applicant will upload a photo of themself and a brief written summary of their professional activities since completion of perfusionist education, to include work history (positions, dates, duties), any lapses in active practice.  If not currently practicing as a perfusionist, please also provide an explanation of the applicant's plans for employment and a description of how the applicant intends to refresh his or her skills;

 

The applicant will arrange for the submission of the following:

 

A letter submitted directly to this office from the appropriate authority verifying the applicant's most recent clinical experience, including dates and evaluation of clinical performance

 

If applicable, verification of all licenses held, current or expired, forwarded directly from the appropriate authority in any U.S. state, territory in which the applicant is or has ever been licensed as a perfusionist.  Most jurisdictions charge a fee for completion of the verification form.   Please contact the jurisdiction for fee information.  Please select this link for the required form.

 

Applications are only accepted online.  In order to submit your reinstatement application online, you will need to know your current user ID and password in DPH's system.  If you do not recall your user ID and password, you can use the recovery options as well as the 'Register' link.  If you use the 'Register' link, please disregard the language under 'PLEASE READ' and select 'NEXT' button at the bottom of the page.  On the next screen, you will need to match your first name, last name and the last 4 digits of your SSN and create a new password and validate your email address.  Please select this link to submit your online application.  The application fee is $315.

 

Typically, applicants who have been out of the active clinical practice for more than five (5) years may be required to complete additional training or take the national examination prior to reinstatement.  Additional information will be provided to applicants upon receipt of an application for reinstatement.

 

All supporting documents should be submitted directly from the source to:

 

Connecticut Department of Public Health

Perfusionist Licensure

410 Capitol Ave., MS# 12 APP

P.O. Box 340308

Hartford, CT 06134

Phone: (860) 509-7603

Fax:  (860) 707-1982

email:  dph.alliedhealth@ct.gov