Perfusionist

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Now Live: Easier Online License Applications and ​Renewals!

​LicensE is your online, self-guided occupational license application platform. 

Please review the helpful links below:

  • Find step-by-step instruction for license renewal here.
  • Find a list of license renewals available via LicensE in the chart on the LicensE Customer Information page.
  • Find all licenses available via LicensE, plus user guides and other resources, on the LicensE Customer Information page.
  • Anyone applying for an initial license for any of the credentials listed can apply at license.wi.gov.

Our LicensE Application Status Lookup tool makes it easier for employees, and helps academic advisors support students during the license application process. To access the Application Status Lookup tool, you will need the applicant's 10-digit PAR number. An applicant may provide the number to anyone who could support their application. Find more information in our news release about this tool. ​​

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​​​​​​​​​​​​​​​Military Medical Personnel Program​

Military Medical Personnel Program participants may temporarily perform certain skilled health services. See Memorandum of Understanding (Form 7158) and Licensure Timeline (Form 7159) for program information.​​

​​License Information

Per Wis. Stat. § 440.08 (2), the required renewal date for the Perfusionist credential is 02/28/ or 29/even years.  Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.


Pre-Credential Education Information

Graduate from a medical board approved perfusion school.

Certification from the American Board of Cardiovascular Perfusion.


Application for Licensure

FormDescription
2562 Credentialing Information for Perfusionist Applicants
​3217​Application for Fee Reduction (If applying for a fee reduction, this form must accompany Form #2562.)
2564Perfusionist Certificate of Professional Education
2565Perfusionist Employment Verification Form
2566​Request for Temporary License for a Perfusionist
​2567​Request for Verification of Certification
2829 Malpractice Suits or Claims Form (if applicable)
​3085​Application for Predetermination (Optional-Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal or state law in this state or any other and you desire a review of your conviction record before applying for a credential.)
2252 Convictions and Pending Charges

Retirement or Inactive Status

There is not a​​ "retired" or "inactive" status for this credential.  If you are retiring or moving out of state, and do not plan to work under your Wisconsin license, you may simply let your license expire. If you choose to allow your license to expire, you may renew it any point within 5 years from the date of expiration by incurring an additional $25.00 late renewal fee.  If your license is expired for 5 years or more and you wish to renew, you will need to complete a late renewal after 5 years application.​

Renewal ​Information

Requirements

  • FEE (See Renewal Dates and Fees)
  • SIG (Signature regarding the completion of Continuing Education, included in on-line renewal and paper form see Continuing Education Information for details)
  • If your legal status as a qualified alien or nonimmigrant lawfully present in the United States has changed since the issuance of your credential or your last renewal, please contact the Wisconsin Department of Safety and Professional Services at (608) 266-2112 or dsps@wisconsin.gov.

Renewal Method

FormDescription
RDAFRenewal Dates and Fees
R210Active Duty/Discharge Renewal Extension
​​2254
​Convictions and Pending Charges​

Wisconsin Act 210 (effective June 1, 2012)

This Act extends the license of a service member if the license expires while they are on active duty from 90 days to 180 days from the date of discharge. The same applies to a spouse of a service member if the spouse does not practice under their license while the service member is on active duty and does not practice because the service member is on active duty.

This Act repeals a provision of prior law that required a service member to meet all of the requirements for license extension or renewal, except for continuing education requirements, in order to have the license extended.

Service members and spouses may request extensions of licenses beyond 180 days from discharge and may request a waiver or extension of time to complete continuing education requirements due to hardship. Please view Active Duty/Discharge Renewal Extension Form #R210.