Clinical Laboratory Technology Exemption Permit for Perfusion

General Information | Applying for an Exemption Permit | Fees | Application Forms

General Information

A Clinical Laboratory Technology Exemption Permit authorizes practice as a perfusionist under the direction and supervision of a physician licensed and currently registered in New York State at a hospital where you are employed on a salaried basis. A Clinicial Laboratory Technology Exemption Permit differs from the Limited Permit for Applicants for Full Perfusion Licensure. Please review the requirements for both permits carefully before applying. Please visit the Perfusion page for more information on both Perfusion licensure and its limited permit.

Education Law section 8609(9) that provides the exemption for this permit expires on October 20, 2018. Applications for this permit that are received after this date will not be accepted.

All Clinical Laboratory Technology Exemption Permits issued on or after October 20, 2016 will expire on October 20, 2018 and cannot be renewed.


Applying for an Exemption Permit

To apply for a Clinicial Laboratory Technology Exemption permit to practice as a perfusionist in New York State, you must submit an Application for Clinicial Laboratory Technology Exemption Permit (Form 5EP) along with the $50 Permit fee to the Office of the Professions. You must also have a Verification of Employment by Hospital (Form 5A) submitted by the Hospital where you are employed on a salaried basis.

A Clinicial Laboratory Technology Exemption permit holder is subject to the full disciplinary and regulatory authority of the Board of Regents, pursuant to Title VIII of the Education Law, as if the Clinicial Laboratory Technology Exemption permit were a professional license under Article 165 of the Education Law.

The Clinicial Laboratory Technology Exemption permit is valid for two years from the date of last issue, or until October 31, 2018, whichever comes first. Clinicial Laboratory Technology Exemption Permits were reissued by this Department at no additional fee in July 2014 when that termination date was extended to October 2018 to include two years from the original date of issue. Clinicial Laboratory Technology Exemption Permits that must be renewed will require the complete application materials, including the attestation of employment by the hospital and the fee of $50.00.


Fees

The Clinicial Laboratory Technology Exemption Permit fee for Perfusionists is $50.

Fees are subject to change. The fee due is the one in law when your application is received (unless fees are increased retroactively). You will be billed for the difference if fees have been increased.

  • Do not send cash.
  • Make your personal check or money order payable to the New York State Education Department. Your cancelled check is your receipt.
  • Mail your application and fee to:

New York State Education Department
Office of the Professions
PO Box 22063
Albany, NY 12201

NOTE: Payment submitted from outside the United States should be made by check or draft on a United States bank and in United States currency; payments submitted in any other form will not be accepted and will be returned.


Application Forms

Form 5EP - Application for Clinicial Laboratory Technology Exemption Permit ( PDF 23 KB)
All applicants for a Clinicial Laboratory Technology Exemption permit must complete this form and submit it with the $50 permit fee directly to the Office of the Professions at the address at the end of the form. Make checks payable to the New York State Education Department. NOTE: Your cancelled check is your receipt.

You must answer all questions and provide all information requested unless otherwise indicated. Failure to complete all required parts of the application will delay its review.

You must also have a Verification of Employment by Hospital (Form 5A) submitted by the Hospital where you are employed on a salaried basis. Your permit cannot be issued until the Department receives and approves all required documentation.

If you change employment after a Clinicial Laboratory Technology Exemption permit is issued, you must obtain a new permit, and with the prospective employer, complete and submit a new Application for Clinicial Laboratory Technology Exemption Permit (Form 5EP), and the $50 permit fee. A new supporting Verification of Employment by Hospital (Form 5A) must also be submitted. The original Clinicial Laboratory Technology Exemption permit must be signed/dated on the back and returned to the Department.

Form 5A - Verification of Employment by Hospital ( PDF 13 KB)

Section I: Complete this section. Be sure to sign and date the affirmation before forwarding both pages of this form to the hospital where you are employed as a perfusionist on a salaried basis.

Section II: Ask the hospital that they complete Section II before submitting all pages of this form to the Office of the Professions at the address at the end of the form. This form will not be accepted if submitted by the applicant.
Last Updated: November 7, 2016