N.C. Department of Health and Human Services
Division of Health Service Regulation
Health Care Personnel Education and Credentialing Section

 

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Forms and Applications

• Registry Change Request Form  (Updated May 2026)
• Nurse Aide Renewal:
  • Online Renewal Form (To be completed by the Nurse Aide)
  • Online Employment Verification Form (To be completed by the Registered Nurse)
• Medication Aide Renewal:
  • Online Renewal Form (To be completed by the Medication Aide)
  • Online Employment Verification Form (To be completed by the Registered Nurse)
• Reciprocity Application (Updated June 2026)
• Reciprocity Application Frequently Asked Questions
• Licensed Nurse Form  (Updated April 2026)

General Information:

• How to Submit Forms and Applications
• How to Submit Identifications
• Notifications (Status Updates)

Important Notices:

• Do not complete the forms using a cell phone.
• Do not enter commas (,) in the text fields to separate information.
• When emailing documents to DHSR, please send either in PDF or Word format.
• Once your form or application has been approved, please allow up to 5 business days for the information to be reflected on the registry website.

• Get Adobe Acrobat
• Email the Webmaster
• Disclaimer

• January 29, 2025
• N.C. Division of Health Service Regulation