Imperial County
Public Health Department

Process for MICN Authorization (Initial)

1. Review Policy #2500 for MICN Authorization
2. Call (442) 265-1444 to schedule an appointment for accreditation

Bring to your appointment the following:

• Completed Application Form (may be completed at time of appointment)
• Current California State Registered Nurse License
• Evidence of current ACLS certification
• Evidence of completion of local MICN Course
• Proof of employment in accordance with Policy #2500
• Proof of ID (CA Drivers License, CA Identification Card, Military ID, Passport)
• Cash or check for $20.00 made payable to the Public Health Dept.

Process for MICN Re-Authorization:

1. Review Policy #2500 for MICN Authorization

2. Mail in required documents and fee or call (760) 482-4768 to schedule an appointment for accreditation

3. Mail or bring to your appointment the following:

• Completed Application Form (may be completed at time of appointment)
• Copy of current California State Registered Nurse License
• Copy of current ACLS certification
• Evidence of required continuing education
• Proof of employment (in accordance with Policy #2500)
• Cash or check for $20.00 made payable to the Public Health Dept. (Please do not send cash by mail)

Forms:

• Policy #2500
• MICN Application Form
• Statement of Certification
• Statement of Affiliation
• MICN Initial Authorization 5/12/14
• MICN Reauthorization 0-12 MOS 5/12/14
• MICN Reauthorization 12-24 MOS 5/12/14