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Overview

The New Mexico Board of Nursing form is a crucial document for nurses and healthcare professionals whose licenses or certifications have expired or lapsed in the state of New Mexico. Designed to ensure accountability and maintain the high standards of healthcare provision, this form requires individuals to declare the status of their license or certification with honesty and precision. It compellingly outlines the need for such professionals to affirm or swear to the specifics regarding their license, including the admission that their credentials have expired or lapsed and any work undertaken during this period without valid licensure. Furthermore, it necessitates the choice between declaring no work performed post-expiration or, conversely, admitting to working with an expired or lapsed license, requiring detailed information about the supervisor and work shifts. A significant emphasis is placed on the attachment of additional documents to support one’s claims, thereby ensuring a thorough and transparent process. The form mandates prompt submission within a designated timeframe post-renewal application, underscoring the seriousness of adherence to procedural timelines. The implications of failing to comply, which could include disciplinary action against one’s licensure, stress the form’s pivotal role in safeguarding professional integrity within New Mexico’s healthcare system. Through its detailed requirements, the form plays an indispensable role in the licensure renewal process, ensuring that all nurses and healthcare professionals meet the state's regulatory standards.

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NEW MEXICO BOARD OF NURSING

ATTESTATION OF EXPIRED/LAPSED LICENSE/CERTIFCIATE

On this _________ day of _______________, 20______, I ___________________________, born on

(Print Name)

________________, swear and affirm as follows:

1.That I allowed my New Mexico License/Certification to expire/lapse. The reason for allowing this to occur is as follows:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Attach additional documents if necessary.

2.Please answer either question A or B below:

a.I attest that I did NOT work any hours/shifts in the State of New Mexico or another compact State, since the date in which my license expired/lapsed: ___________.

(Initial)

OR

b.I attest that I DID work on an expired/lapsed license. __________.

(Initial)

i.Supervisors Name: _____________________________

ii. Supervisors Telephone: (

) ___________________

 

 

 

 

iii.Supervisors email Address: _____________________________

iv.Number of days/shifts worked in the State of New Mexico since the date in which my license expired/lapsed: __________________________

v.I have attached a list or payroll records of all dates and hours worked at a job related to my license/certificate from this day going back to the date when my license/certificate expired. ___________. (This also needs to be signed by your

supervisor).(Initial)

3.I understand this attestation as well as any supporting documents need be returned to the NMBON no later than 5 business days following the date of submission of my renewal application. Failure to provide this attestation within the time period required could result in disciplinary action taken towards my New Mexico licensure/certificate ___________.

(Initial)

I swear or affirm that the above and foregoing representations are true and correct to the best of My information, knowledge, and belief.

____________________

__________________________

______________

Print Name

Signature

Date

Any misrepresentation on this attestation can lead to disciplinary action and will be forwarded to the Compliance Division for investigation.

Document Properties

Fact Detail
Form Purpose To attest to the status of an expired or lapsed New Mexico nursing license or certification.
Required by New Mexico Board of Nursing (NMBON)
Reason for Expiry/Lapse Disclosure Licensee must disclose the reason(s) for allowing their license or certificate to expire or lapse.
Work Status Attestation Licensee must attest whether they have or have not worked with an expired or lapsed license in New Mexico or another compact state.
Supervisory Information If worked with an expired/lapsed license, details about supervisor and shifts worked are required.
Submission Deadline Attestation and any supporting documents must be returned to the NMBON within 5 business days following the application for renewal submission date.
Penalties Failure to provide this attestation within the required time frame could result in disciplinary action against the New Mexico licensure/certificate.
Governing Laws New Mexico Nursing Practice Act

Steps to Filling Out New Mexico Board Of Nursing

Filling out the New Mexico Board Of Nursing Attestation of Expired/Lapsed License/Certificate form is a crucial step for nurses who have allowed their license or certificate to lapse but wish to return to practice. The process requires attention to detail and completeness to avoid any delays or disciplinary actions. Here is a step-by-step guide designed to help you complete the form accurately and efficiently.

  1. Start by entering the current date in the space provided: "On this _________ day of _______________, 20______".
  2. Print your full name in the designated space following "I___________________________, born on".
  3. Fill in your birth date where indicated.
  4. In the space provided, explain in detail why your New Mexico License/Certification was allowed to expire/lapse. Be thorough and attach additional documents if necessary to fully explain your situation.
  5. Decide between question A or B in section 2, depending on your situation. If you did not work any hours/shifts after your license expired/lapsed, initial beside statement A. If you did work, initial beside statement B and provide the required details about your supervisor and the number of days/shifts worked.
  6. If you chose statement B, remember to attach a list or payroll records showing all dates and hours worked related to your license/certificate from the day it expired up until now. Ensure this document is also signed by your supervisor.
  7. Read statement 3 carefully, understanding that this attestation and any supporting documents need to be returned to the New Mexico Board of Nursing (NMBON) within 5 business days following the submission of your renewal application. Initial to acknowledge.
  8. Review your entries to ensure all information provided is accurate and true. Any misrepresentation can lead to disciplinary action.
  9. Complete the form by printing your name, signing, and dating at the bottom where indicated.

Once you've filled out the form and checked all the information for accuracy, submit it along with any required supporting documents to the NMBON by the stated deadline. Making sure everything is in order will help smooth the process and get you back on track professionally.

Frequently Asked Questions

  1. What is the purpose of the attestation form for expired/lapsed license/certificate by the New Mexico Board of Nursing?

    The attestation form serves a critical purpose for nurses who have allowed their New Mexico nursing license or certification to expire or lapse. By completing this form, an individual formally acknowledges the expiration or lapse of their license and provides detailed information about any work performed during this period without a valid license. It's a step in the process of renewing or restoring a nursing license in New Mexico, ensuring that the nurse meets all regulatory requirements and provides transparency about any unauthorized practice. This documentation helps the New Mexico Board of Nursing (NMBON) assess the situation and determine the appropriate course of action, which may include additional requirements for the nurse or potential disciplinary action if necessary.

  2. What should I do if I worked with an expired/lapsed license?

    If you worked with an expired or lapsed license, you must select option "b" on the attestation form, indicating that you did engage in work during the period your license was not active. It is essential to provide all requested details, such as the supervisor's name, contact information, the number of days or shifts worked without a valid license, and attach any required documentation such as a list or payroll records indicating the dates and hours worked related to the license. Additionally, ensuring that your supervisor signs the provided documentation will verify the accuracy of your claims. This honesty and transparency are crucial in addressing the issue with the NMBON and moving forward in the renewal or restoration of your license.

  3. What happens if I do not submit the attestation form within five business days after submitting my renewal application?

    Failure to submit the attestation form within the specified five-business-day timeframe after submitting your license renewal application can lead to disciplinary action against your New Mexico licensure/certificate. The Board takes the timeline seriously to ensure a prompt and orderly process for license renewals and to address any issues related to expired or lapsed licenses swiftly. To avoid any potential disciplinary action, it is advisable to prepare this form in advance and submit it as soon as possible after completing your renewal application, ensuring compliance with the NMBON's requirements.

  4. What are the consequences of misrepresentation on the attestation form?

    Any misrepresentation made on the attestation form is taken seriously by the New Mexico Board of Nursing and will be forwarded to the Compliance Division for investigation. Misrepresentation can include providing false information or omitting relevant facts about your work history or licensure status. Such actions can lead to disciplinary measures against your license or certificate. These measures are intended to maintain the integrity of the nursing profession and ensure that all practicing nurses in New Mexico comply with state laws and regulations, safeguarding patient safety and trust in the healthcare system.

Common mistakes

When filling out the New Mexico Board of Nursing form for the attestation of expired/lapsed license/certificate, applicants commonly make several mistakes that can delay the process or affect the outcome. Avoiding these errors is crucial for a successful submission.

  1. Failing to provide a clear reason for the license/certification lapse: It's essential to explain thoroughly why the license was allowed to expire. This helps the board understand the circumstances and make informed decisions.
  2. Not choosing between question A or B: Applicants must specify whether they worked with an expired/lapsed license by answering either question A or B. Overlooking or not clearly initialing the chosen response can be problematic.
  3. Omitting supervisor's contact information: If admitting to working with an expired license, providing complete and accurate supervisor information is necessary. Neglecting these details can lead to verification issues.
  4. Forgetting to attach a list or payroll records of work done after license expiration: When indicating that one has worked despite an expired license, it's compulsory to attach documented proof of work dates and hours. Missing documentation can raise credibility issues.
  5. Not respecting the submission deadline: The attestation and any supporting documents must be returned to the NMBON within 5 business days after submitting the renewal application. Late submissions can lead to penalties or disciplinary action.
  6. Misrepresentation of information: Any false representation deliberately made on the attestation is taken seriously and will be forwarded to the Compliance Division for investigation, potentially leading to disciplinary action.

Beyond these common mistakes, it is vital to review the entire document for accuracy and completeness before submission. Given the potential consequences of delays or disciplinary action, taking the time to ensure everything is correct is in every applicant's best interest.

Documents used along the form

The process of reactivating an expired or lapsed nursing license with the New Mexico Board of Nursing (NMBON) involves several steps, which often require submitting additional forms and documents alongside the New Mexico Board of Nursing Attestation of Expired/Lapsed License/Certificate form. These supporting documents are essential for providing evidence of the licensee's qualifications, work history, and adherence to regulatory requirements. Here is a brief overview of other forms and documents that might be necessary in this context.

  • Proof of Identity Document: Typically, this could include a government-issued photo ID such as a driver's license or passport. This document is necessary to verify the identity of the applicant.
  • Verification of Licensure: If the applicant has been licensed in another state, verification from that state's board of nursing is required to ensure the license was in good standing before it expired or lapsed.
  • Continuing Education Certificates: Nurses may need to demonstrate that they have completed any required continuing education units (CEUs) since their license lapsed. These certificates provide evidence of completion.
  • Criminal Background Check: A fingerprint-based criminal background check is often mandatory for licensure. This document helps assure the board of the applicant's good character.
  • Employment Verification Letter: For applicants who worked with an expired or lapsed license, a letter from their employer verifying dates of employment and job duties can be necessary.
  • Professional References: Letters from colleagues or supervisors attesting to the applicant’s professional competence and ethical behavior might be requested to support the application.
  • Explanation Letter: In some cases, the board may require a detailed explanation of the circumstances that led to the licensure lapse. This letter should provide a clear and honest account of the situation.
  • Payment Receipts: Proof of payment for the renewal fee and any additional fines or fees associated with the lapsed license may be required to process the application.

Collecting and submitting these documents in conjunction with the New Mexico Board of Nursing Attestation of Expired/Lapsed License/Certificate form is a crucial step toward reinstating a nursing license. Applicants should ensure that all information provided is accurate and up-to-date to avoid further delays or complications in the renewal process. This thorough documentation helps safeguard the high standards of nursing practice and patient care in New Mexico.

Similar forms

The New Mexico Board of Nursing form shares similarities with professional licensure reinstatement forms from other states. Like those forms, it requires the licensee to acknowledge a lapse or expiration of licensure and to provide reasons for such an occurrence. The detailed disclosure of whether the licensee has worked during the period of lapse, similar to other states’ requirements, emphasizes accountability and the need for transparent communication about licensure status. Additionally, the demand for initialing statements and providing supervisory information mirrors the structured approach of other states aimed at verifying the claims made by the applicant. This form, by necessitating an attestation to the truthfulness of the information provided, aligns with the broader professional licensure framework which prioritizes integrity and public safety.

Similarly, the form also resembles criminal background check consent forms often required for professional licensure or employment. Both types of documents necessitate the applicant's consent to verify their claims and ensure their eligibility. In the nursing form's context, attesting to whether one has worked on an expired license requires honesty and accountability, akin to disclosing personal history on a background check consent form. The element of attesting to the accuracy of information, under the seriousness of potential disciplinary action, further parallels the gravity with which criminal background checks are treated. Both serve as critical gatekeeping steps to ensure the integrity and safety of the profession and the public.

The structure and intent of the New Mexico Board of Nursing form also show significant resemblance to employment verification forms. Both demand specific details regarding employment history, including supervisor contact information and the duration of employment, to validate the experience related or pertinent to one's professional license. The requirement to attach additional documents, such as payroll records, is a commonality that underscores the need for substantive evidence to support one's claims. These forms enable regulatory bodies or employers to ensure that individuals meet requisite standards or conditions, reinforcing the parallel in their use for verification and vetting processes.

Dos and Don'ts

When completing the New Mexico Board of Nursing form for attestation of expired/lapsed license/certificate, it's important to follow certain guidelines to ensure the process is smooth and complies with the board's requirements. Here are some dos and don'ts to keep in mind:

  • Do ensure that all information provided on the form is accurate and truthful. Accuracy is paramount to avoid any potential disciplinary actions.
  • Do attach any additional documents that support your reason for allowing the license/certification to expire or lapse, if necessary.
  • Do choose the correct option between question A and B, based on your situation regarding work performed with an expired or lapsed license.
  • Do include the name, telephone number, and email address of your supervisor if you worked during the period your license was expired/lapsed, as required.
  • Do attach a list or payroll records detailing all dates and hours worked related to your license/certificate since it expired/lapsed, if applicable.
  • Do not wait until the last minute to submit the attestation and any supporting documents. They must be returned to the NMBON no later than 5 business days after submitting your renewal application.
  • Do not leave any sections incomplete. If a section does not apply, indicate as such instead of leaving it blank.
  • Do not attempt to submit the form without the required initialing of statements. Each statement that requires an initial is crucial for the validity of the attestation.
  • Do not disregard the seriousness of any misrepresentation on this attestation. Be aware that any false information can result in disciplinary action and will be subject to investigation by the Compliance Division.

Following these guidelines can assist in a more streamlined process, helping to avoid unnecessary delays or complications with the renewal or reinstatement of your nursing license or certificate in New Mexico.

Misconceptions

Understanding the New Mexico Board of Nursing (NMBON) form for attestation of expired or lapsed licenses requires clear and accurate information. Below, several common misconceptions are addressed to ensure clarity and compliance.

  • Misconception 1: Any reason for allowing a license to expire or lapse is acceptable. While the form does solicit an explanation for the lapse, it's important to understand that the reasoning provided is part of an evaluative process by the NMBON, which may influence their decision on renewal or any disciplinary actions.
  • Misconception 2: A choice between question A or B indicates flexibility regarding unauthorized work. This choice is designed to disclose whether there was any employment during the lapse without valid licensure. It's crucial to remember that working with an expired or lapsed license can lead to serious consequences, regardless of the choice made on the form.
  • Misconception 3: Supervisory sign-off negates non-compliance. While obtaining a supervisor's signature on paperwork that details any work done while the license was lapsed might seem like a form of approval, it does not exempt an individual from possible disciplinary action by the Board.
  • Misconception 4: Submission of the attestation form alone suffices for license renewal. The attestation is part of the documentation required for renewal for those with expired licenses. However, it doesn't replace other renewal requirements, such as completing continuing education credits or paying renewal fees.
  • Misconception 5: The form's deadline is flexible. The requirement to submit the attestation and any supporting documents within 5 business days following the renewal application's submission is strict. Late submissions can lead to penalties or the denial of the renewal application.

Correct understanding and adherence to the requirements as detailed in the attestation form are essential for those looking to renew their nursing license in New Mexico, especially after a lapse. It's crucial to approach this process with the seriousness it deserves to maintain professional licensure and compliance.

Key takeaways

Filling out and using the New Mexico Board of Nursing (NMBON) attestation of expired/lapsed license/certificate form is a mandatory process for nurses whose licenses have expired or lapsed. Understanding the key components of this form can assist nurses in navigating through the renewal and reinstatement process more effectively. Here are seven key takeaways that are critical when dealing with this form:

  • Accurate Information is Crucial: Nurses must provide accurate information regarding their name, date of birth, and the specific details surrounding the expiration or lapse of their license. This includes the exact reasons for allowing the license or certification to expire.
  • Documentation of Employment History: The form requires the nurse to attest whether they have worked any hours or shifts in New Mexico or another compact state since their license expired or lapsed. It's important to disclose any employment accurately, as working with an expired license may have legal implications.
  • Supervisory Confirmation: If a nurse has worked with an expired or lapsed license, the form mandates providing details about the supervisor including their name, telephone number, and email address. This information is necessary to verify the employment history related to the lapsed license.
  • Deadline for Submission: Nurses are required to return the attestation form and any supporting documents to the NMBON within 5 business days following the submission of their renewal application. Timely submission is essential to avoid disciplinary actions that may affect licensure status.
  • Disciplinary Actions for Non-Compliance: Failure to comply with the stipulated deadlines or providing false information can lead to disciplinary actions against the nurse's license. It emphasizes the importance of being truthful and responsible in the renewal process.
  • Evidence of Work History: For those who worked during the period their license was expired, attaching a list or payroll records of all dates and hours worked is necessary. This part of the attestation process underlines the need for maintaining thorough employment records.
  • Attestation of Truthfulness: The final section of the form is a declaration by the nurse attesting to the truth and accuracy of the information provided. It's a legal acknowledgment that any misrepresentation on the attestation can lead to disciplinary action and will require an investigation by the Compliance Division.

Understanding and carefully addressing these key aspects of the NMBON attestation form can help ensure that the process of license renewal or reinstatement proceeds smoothly and without complications. It's a crucial step for nurses in New Mexico to maintain their professional credentials and to continue providing healthcare services legally.

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