OMS Recertification

*Name as it appears on your professional license

Agreement Authorization and Certification Information Release

By submitting this OMS Recertification Application, I acknowledge that all supporting documentation provided is true and accurate. If the activities listed on the OMS Activity Report or the supporting verification documents are falsified in any fashion, I understand that this will result in the revocation of my OMS credential.

I affirm that I am currently licensed to practice as a in the state of .

I further affirm that no licensing authority has current disciplinary action pending against my license to practice in the aforementioned or any other state, and that my license to practice is not currently suspended, restricted or revoked by any state or jurisdiction.

I authorize the National Alliance of Wound Care and Ostomy® Certification Board to make whatever inquires and investigations that it deems necessary to verify my credentials and professional standing. I further allow the National Alliance of Wound Care and Ostomy® Certification Board to use information from my application for the purpose of statistical analysis, provided my personal identification with that information has been deleted.

I have read and understand all the information provided in the NAWCO® recertification handbook. I further agree to abide by the policies and procedures as set forth in the NAWCO® recertification handbook and all conditions included in the NAWCO® candidate recertification agreement.

For listing in the National Alliance of Wound Care and Ostomy® Directory, I hereby authorize the National Alliance of Wound Care and Ostomy® its licensees, successors, and assigns (collectively “NAWCO®”) the right to publish and release my name, past and present certification status under the NAWCO® OMS Certification Directory, and state/province (collectively “Certification Information”) in print and electronic versions of a worldwide directory of NAWCO® OMS Certified Practitioners.

If the NAWCO®, is required by law to release your confidential information, you will be notified by email at the address we have on file, unless prohibited by law. I release the NAWCO®, its subsidiaries and affiliates and their employees, successors, and assigns from any claims of damages for libel, slander, invasion of rights of privacy or publicity, and any other claim based on the publication or release of any Certification Information as specified in this Certification Information Release.

I agree to make claims regarding certification only with respect to the scope for which the certification has been granted. I agree to discontinue use of the OMS credential and promotion of the certification immediately upon expiration, suspension or withdrawal of certification. I further swear to notify the NAWCO® in writing within 10 business days if I learn I am no longer eligible to hold the OMS credential, such as in the event of suspension, placement of restrictions upon or revocation of the primary professional license. I understand that failure to notify the NAWCO® of any of the above listed disciplinary actions will result in revocation of certification and/or denial of recertification. In the event of revocation of the credential, I agree to destroy the Certificate of Certification.

By signing this agreement, I hereby swear and attest to all the contents of the Candidate Recertification Agreement Policy/ Statement of Understanding contained within this Candidate Recertification Handbook. I also attest that I am aware of and acknowledge that there are no refunds granted for any reason, once this application has been submitted and payment has been made.

I have read and agree to abide by the NAWCO Code of Ethics as listed in the Candidate Handbook