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Division of
Professional Regulation

 Pages Tagged With: "forms"

Report of Healthcare Provider

INSTRUCTIONS This form is for the use of Delaware-licensed healthcare providers and certain other entities that have a mandatory duty to report Delaware-licensed medical practitioners or other healthcare providers under Delaware law and regulations. For complete information on who must report and what must be reported, see Mandatory Reports Related to Healthcare Providers on the […]

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Media Inquiries

Please fill out the form below in its entirety and click Send Comments to contact the Division of Professional Regulation. All media inquiries are designated high priority. A Division representative will respond to your inquiry shortly. News Agency: Email: Name: Telephone: Anticipated Publish Date: Information Requested: Briefly describe the purpose of the information requested: Submit    Reset

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Forms 

Vendor and Vendor Representative Application for Registration as a Vendor of Tamper-Resistant Prescription Forms Vendor Representative Change Reporting Form   Institutional Provider Application for Authorization to Purchase Tamper-Resistant Prescription Forms as an Institutional Provider

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Forms

Application Application for Licensure as a Clinical Social Worker Documentation of Attempts to Secure LCSW Supervision Federal Bureau of Investigation Non-Criminal Justice Application’s Privacy Rights   Inactive Status Request for Inactive Status

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Forms

>Delaware Professional Regulation,Council – Real Estate Appraisers – Forms

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Forms

Change Requests License Status Change Form (Request for Transfer/Inactive Status/Termination or Cancellation of License) Request to Change Broker Type Request to Reactivate Real Estate License   Brokers and Salespersons Application for Real Estate Salesperson Licensure Application for Real Estate Broker or Associate Broker Licensure Application for Reinstatement of Real Estate License Application for Additional Real Estate License Sales […]

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Forms

Psychologist Application for Licensure as a Psychologist by Examination Application for Licensure as a Psychologist by Reciprocity Federal Bureau of Investigation Non-Criminal Justice Application’s Privacy Rights     Psychological Assistant Application for Psychological Assistant Registration Supervision Report for Psychological Assistants – Registration Renewal Psychological Assistant Report of New Supervisor Psychological Assistant Report of Releasing Supervisor

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Forms

Applications Application for Licensure to Practice Podiatric Medicine Podiatric Physician In-Training Application Application for Temporary Podiatrist Licensure Federal Bureau of Investigation Non-Criminal Justice Application’s Privacy Rights   Continuing Education Request for Approval of Continuing Education Approval

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Forms

Apprentice Pilot   Upgrade Forms Complete this application to advance to the next class. Complete, sign, and notarized the River Pilot Application to Advance to Higher Class Complete this form only when advancing from 4th class to 3rd class – Squat Certification   Other Forms Merchant Mariner Physical Examination Report

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Forms

For forms related to Controlled Substance registration, click Controlled Substances Forms.   Intern Registration Application for Registration of Internship – U.S. School Application for Registration of Internship – Foreign School Affidavit of Preceptor Affidavit of Intern Experience Form Practical Experience Program for Pharmacy Preceptors and Interns   MPJE Study Material MPJE Study Material   Pharmacist […]

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