Application & Instructions for Initial Licensure - Polysomnography

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.

To access a paper application, click HERE (available for a limited time)

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.

Photograph
   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.

To be eligible for a technologist license, an applicant shall:

  1. be at least 18 years of age;

  2. be of good moral character as defined by this Chapter;

  3. be a high school graduate or have the equivalent of a high school diploma;

  4. have a current credential as a polysomnographic technologist which is granted on the basis of written examination by one of the entities identified in §3319 (BRPT or ABSM);

  5. hold current certification in basic cardiac life support or cardiopulmonary resuscitation from a nationally    recognized and accredited training organization;

  6. be a citizen of the United States or possess valid and current legal authority to reside and work in the United States, duly issued by the Citizenship and Immigration Services of the United States, Office of Homeland Security, under and pursuant to the Immigration and Nationality

To be eligible for a technician permit, an applicant shall:

  1. meet and satisfy all of the qualifications for licensure specified above, save for current certification as a registered polysomnographic technologist by the BRPT or registered sleep technologist by the ABSM on the basis of written examination;

  2. have:

  • passed the (entry-level CPSGT) certification examination offered by the BRPT; or

  • completed an accredited CAAHEP education program in polysomnography

Additional Requirements

Fees
Technologists Licensure - $150.00
Technician Permit - $100.00
Fee must be paid via credit/debit card (Visa, MasterCard or Discover only) if applying online.
Fee must be paid via Personal check/money order if sending in a paper application.
​Fee is non-refundable.

Birth Certificate/Valid Visa

  • U.S. born citizen - submit a notarized copy of birth certificate

  • U.S. citizen not U.S. born - submit notarized copy of proof of citizenship (ie certificate of citizenship or consular report of birth abroad). Naturalized citizen - submit a notarized copy of birth certificate and notarized Certificate of Naturalization.

  • Non U.S. citizen - submit a notarized copy of birth certificate and notarized current Visa issued by the U.S. Citizenship and Immigration Services. (Acceptable Visas: H1B, J1, O1, NAFTA-TN or Employment  Authorization, or Permanent Resident)

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.

Transcript

  • If graduated from a CAAHEP accredited education program in Polysomnography, an official transcript must be mailed from the school directly to the LSBME.

  • If haven't graduated from CAAHEP accredited program in Polysomnography, an official high school transcript mut be mailed from the school directly to the LSBME.

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.​

Cardiac Life Support 
Submit a notarized copy of current certification in basic cardiac life support or cardiopulmonary resuscitation from a nationally recognized and accredited training organization (or mail original with a self addressed stamped envelope).

Other Information

Verification of Application/Licensure Status
Visit our website at www.lsbme.la.gov 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 licensing@lsbme.la.gov. To find the analyst directly assigned to your application, click on Contact Us.