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Surgery assistant perfusionist operating a modern heart lung machine with artificial cardiac valve at operating room in cardiology clinic.
Professions

Perfusionist – Renewal After 5 Years

For individuals who held a Perfusionist credential in WI, but the credential has been expired for 5 years or more.

Credential Statute: Wis. Stat. Sec 448
Credential Code: Chapter Med 22

  • Disclaimer: Please review WI statute for full professional requirements. 

Related Boards: Medical Examining Board and Perfusionists Examining Council


Overview

This page is the subsite for applicants who reapply after a licensure lapse due to any of the following: · Previous license expired more than five years ago · License revocation · Voluntary license surrender · Board order specifically requiring reapplication

Before You Apply

You must have a previous Wisconsin Perfusionist license that expired more than 5 years ago, or that lapsed for one of the other reasons above. If your previous license expired less than 5 years ago and you don’t see the option to renew it in your LicensE account, please use the Request Support feature in LicensE for assistance.

How to Apply

Below are some general instructions for applying for a credential on LicensE. 

  1. Create or log into your LicensE account. Please visit LicensE account Information page for detailed guidance on selecting your account type.

  2. Select "Apply for a License."

  3. Select your Category.

  4. Select your License Type.

  5. Select your Application Method, then "Next."

  6. Review your Personal Information.

  7. Enter the requested Information on each page of the application. Information may include Examination, Education, or License History, depending on your profession.

  8. If applicable, request a Veterans Fee Waiver or Initial Credential Fee Reduction.

  9. Submit the requested Documents you may already have. You do not need to have all documents ready to submit.

    Note: Forms are now hosted on AccessGov. Visit AccessGov Forms Directory to choose your form.

  10. Respond to the Attestation questions.

  11. Provide Payment Information. Fees may be found Credential Fees.

  12. Submit your application.  

Profession specific application requirements can be found in the "Application Information" section.

Application Information

After logging in, select Apply for a License and choose:

· Category: Health

· License Type: Perfusionist

· Application Method: Renewal After 5 Years

· Practice: Enter your activities for at least the last 10 years, or from graduation to present if you graduated less than 10 years ago.

Please Note: You are not required to provide all documents before initial application submission. You do not need to upload documents to every available category

Upload certificates showing at least 30 continuing education units within the last 2 years, including at least 10 continuing education units in activities listed as Category I in Wisconsin Administrative Code.

(Form 2565) – Follow the instructions on the Form 2565. Have each employer in the last 10 years (or from graduation to present if you graduated less than 10 years ago) submit the form directly to us.

Contact other state boards to have verifications sent directly to us from each state where you have ever been licensed. We can accept verifications by email (DSPSCredMedBdAffiliates@wisconsin.gov), postal mail, or the LicensE third party upload portal.

Questions and clarifications about your application should be submitted as support tickets in LicensE. Email addresses provided for document submission are not monitored for support purposes. After a document is emailed, you can submit a support ticket to alert our staff.

Exam Information

In some circumstances, you may be required to complete an oral examination. We will notify you if this is required.

What Happens Next?

After you upload all required documents, submit your application, and pay the required fee(s):

  1. Preliminary Application Reference Number (PAR)

    1. Your application will be assigned a Preliminary Application Reference number or PAR number. This number allows you and trusted parties to look up the status of your application without logging in. You can also reference this number in any support tickets you submit in regard to your application.

      • A trusted 3rd party can look up your credential status by visiting LicensE, clicking “Application Status Lookup” and entering the PAR number you have provided to them.

  2. Review Timeline

    1. Your materials will be reviewed within approximately 10 days by a member of the credentialing team.

      • Note: Some licenses do take longer to process due to complexity. You can see the performance data on our LicensE Dashboard to see what date we are reviewing for certain application types under "Application Review Times by Profession."

  1. Pending Applicant Input Status

    1. After this review, if anything is missing or the credentialing team has any questions on your application, your application will go back into a status called “Pending Applicant Input.”  You will receive an email letting you know your application was moved into this status. You should then log into LicensE and check your application “Due Diligence.”

  1. To check your "Due Diligence" 

    1. Your Due Diligence is a checklist of items required for your credential.

    2. The Due Diligence section is how DSPS staff will communicate with you regarding your credential requirements.

    3. Log in to your LicensE account

    4. Click on "Check Application Status" 

    5. Your credential application should be shown on this page. Under “Action” select the button that looks like an upside-down triangle. If you are on mobile, you will need to turn your phone into landscape view. Note: LicensE is best viewed on a desktop or laptop.

    6. After clicking the upside-down triangle, select “View Due Diligences.”

    7. The Due Diligence column lets you know what the requirement is.

    8. The “STATUS” column will you know if the item is “Met”, “Not Met”, or “Not Applicable.”

      • Items listed as “Not Met” are items that are needed by the Department.  

    9. The “NOTES” column of your Due Diligence will provide further written details or instructions about what is still needed.

  2. To upload documents

    1. Some applications require additional document uploads.

    2. Log into your LicensE account

    3. Click on "Check Application Status"

    4. Your credential application should be shown on this page. Under "Action" select the button that looks like an upside-down triangle. If you are on mobile, you will need to turn your phone into landscape view. Note: LicensE is best viewed on a desktop or laptop. 

    5. After clicking the upside-down triangle, select "Upload Document."

    6. The document must be an allowable document type. 

    7. After uploading the document, click "submit." If you do not, it will not be sent to a reviewer. 

  3. If you have any questions, you can submit a support ticket on LicensE by logging in and clicking "request support" at the top of the page.

LicensE statuses that require action from applicant:

Status

Description

Pending Applicant Input

The application is with the applicant to submit additional documentation and/or information.

Pending Exam

The Department is waiting for the applicant to complete a required examination and receive passing results.

LicensE statuses that indicate the application is with Department staff:

Status

Description

Credentialing Team Review

The application is in the queue of a DSPS team member and awaiting review.

Legal File Preparation

The application is with a member of the legal team who is compiling arrest/conviction documents for review by an attorney.

Legal Review

The application is with an attorney, or another member of the legal team who performs the actual review.

Board Review

The application is with board liaison and/or the board for determination.

Awaiting Regulatory Authority

The application sent to regulatory authority (Chief Legal Counsel) for determination.

Discipline and/or Monitoring

Application is with legal staff but will be held until Division of Legal Services and Compliance disciplinary matter is resolved. 

Contact Us

Support Ticket
Submit a support ticket on LicensE and click "request support." Please provide as much detail as possible regarding your concern so we can work to answer your question with a one touch resolution. 

Call
608-266-2112

Email
dsps@wisconsin.gov

Office Hours
7:45am-4:30pm
Department of Safety and Professional Services
4822 Madison Yards Way
Madison, WI, 53705

Note: The in-person office does not process same day.

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