Two-Year CE Summary For License Renewal

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This form may be submitted upon completion of the required CE hours. Early submission is encouraged and may assist in more timely renewal processing.
I,*
,O.D., Nevada License Number*
hereby submit copies of documents reflecting my attendance at or participation in sufficient courses to fulfill the continuing education requirements for license renewal pursuant to NRS 636.260 and Board Policy Number 5. I completed the following courses between March 1st of the current license period and the date entered below:
I have general optometric continuing education credits, including not more than the maximum allowable hours of practice management coursework, totaling:*
I hold a Nevada Optometric Pharmaceutical Agent certificate (OPAC) and have completed approved continuing education hours related to pharmaceuticals, totaling:*
I hold a federal DEA number and a Nevada CS number, and have completed substance/opioid abuse related continuing education, totaling:*
Total Hours.
I have provided my OETracker report (or CE attendance certificates for any coursework not included in the OETracker report, or both) in support of my total CE above. I swear the foregoing information is true under the pains and penalties of perjury.
Upload OETracker report and/or CE attendance certificates.
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- Dated :*
  MM slash DD slash YYYY
- Email :
*
- By submitting this information and checking this box, I affirm that each document is complete and correct and that all information contained in this submission is true under the pains and penalties of perjury and the requirements of NRS Chapter 636 and NAC Chapter 636 and Nevada law generally. I also acknowledge that if I have directed or authorized a person to complete or submit this information on my behalf, I, the optometrist licensed by the Nevada Board of Optometry, am fully responsible for the content of the submission.
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Two-Year CE Summary For License Renewal

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