Application & Instructions for Initial Licensure - Perfusionist

Log in to LaMED DashBoard to begin a new online initial application, complete a previously started (and saved) online initial application or to check the status of your completed online initial application.

The items listed below MUST be completed and mailed to the LSBME as part of the initial application process.

Note: notarized documents must be signed in the presence of a notary.

Oath or Affirmation
This form must be notarized. All yes answers must be accompanied by a sworn affidavit. A sworn affidavit is an explanation (in applicant’s own words) that must be typed and notarized. Note: If criminal history is found that you did not disclose, you will be required to submit a new Oath or Affirmation, a notarized affidavit as to why you did not disclose the information and a new processing fee equal to the initial licensure fee. It is important that you answer question 3 accurately and truthfully. Do not take the advice of friends, lawyer, etc.

Third Party Authorization
This form must be notarized. It authorizes LSBME to obtain information concerning the applicant from third parties.

Certificate of Dean/Registrar
Complete Section 1 as directed. Mail to professional school/university for completion of Section 2. The school/university must mail the completed form directly to LSBME.

   A passport quality photograph must be submitted.  This photo must be a 2"x2" clear, head and shoulders photo taken within the last 6 months.

Background Check
LSBME conducts background checks as part of the application process. Instructions and forms can be found at the link above.

Additional Requirements

Licensure - $300.00.
Provisional License - $200.00
Fee must be paid via credit/debit card (Visa, MasterCard or Discover only).
​Fee is non-refundable.

Birth Certificate/Valid Visa

  • U.S. citizen - submit a notarized or certified copy of your birth certificate.
  • U.S. citizen not born in the U.S. - submit a notarized copy of your certificate of citizenship, consular report of birth abroad or certificate of naturalization.
  • Non-U.S. citizen - submit a notarized copy of current proof of citizenship.  Acceptable forms of citizenship are an H1B Visa, J1 Visa, O1 Visa, TN Visa, Permanent Resident card or Employment Authorization card.
  • Louisiana law (LA RS: 37.12) requires a valid permit to live and work in the United States to practice medicine.
  • J1 Visas are structured for training and educational purposes only.  The typical sponsor for a Medical Doctor’s J1 Visa is the ECFMG.  A J1 visa is not for employment outside of a formal training program.
  • H1B Visas are intended for those who are performing a specialized service or occupation.  These Visas are usually sponsored by hospitals or a particular employer.
  • The LSBME works with the United States INS to grant interlocking letters to obtain an effective date for the H1B Visa.  The effective date of the Visa will be the effective date of the Louisiana license or permit issued by the LSBME.
  • The applicant’s employer usually needs a valid LSBME license to complete the credentialing process for hospitals, insurance companies, and professional liability insurers.  Therefore, the licensure applicant should work with the United States INS Visa sponsor to set the effective date for the Visa. 

Marriage Certificate/Name Change
Application for licensure in a name other than what appears on the birth certificate requires a notarized copy of official documentation of name change (ie marriage certificate).

Notarization as a “true copy”
   Request the notary to certify a copy of your birth certificate and/or marriage certificate as a “true and correct copy of the original”. If the notary will not certify the document,
   you can attest that it is a “true and correct copy of the original”. The notary can then notarize your signature.

ABCP-American Board of Cardiovascular Perfusion
To request verification of ABCP certification, contact ABCP (601) 268-2221 or email The verification must be sent directly to LSBME.

  • Licensure applicants - must be currently ABCP certified.

  • Provisional license applicants - must meet all requirements for licensure save for passage of the ABCP examination.  After successful examination, verification must be sent directly to LSBME from ABCP.

Verification of Other Licenses
Verification of all state licenses are required.  Contact the state board(s) directly to obtain verification of your license.  Please note, there may be a processing fee needed.​

Other Information

Verification of Application/Licensure Status 
Visit our website at and log on to your account to verify the progress/status of your application.

Communication with the Board
Mailing Address - LSBME, 630 Camp Street, New Orleans, LA 70130
Questions - Contact our licensing department at To find the analyst directly assigned to your application, click on Contact Us.