IOWA BOARD OF NURSING
RIVERPOINT BUSINESS PARK 400 SW 8TH ST SUITE B DES MOINES, IA 50309-4685 INFORMATION AND INSTRUCTIONS FOR THE PURCHASE OF A ROSTER The following information includes an order form, a Purchase of Roster Agreement, cost information, and a map of Iowa showing the nursing population by county. 1. Order Form. Complete all sections of the order form. Missing specifications may result in delays in processing your order. Unless you specify otherwise, the roster will include names, addresses and county numbers. E-mail addresses and phone numbers are not available. Social Security numbers and license numbers cannot be released. Purchase of Roster Agreement. A signed Purchase of Roster Agreement is required before the order can be processed. The agreement affirms that the materials or publications to be disseminated shall not be published in a manner which could be construed by the public to mean that the Board supports, endorses, or approves of the materials disseminated. Be sure to include the company name, street address, telephone number and e-mail address on the Purchase of Roster Agreement, so that you can be contact with any questions. Cost and Payment Information. Cost and payment information changed effective on August 9, 2006. Please refer to enclosed cost information sheet. 4. The use of purchase orders. If an order is not pre-paid, but a purchase order is received with the order, the roster can be shipped and billed simultaneously. But if neither a purchase order or payment is received, you will be invoiced, and the roster will be shipped when payment has been received. The Iowa Board of Nursing is not able to accept payment by credit card. The roster cannot be released until payment or a purchase order has been received. 5. Overnight or express mail service is available only if the request is accompanied by your billing account number. Orders are processed within 6 - 10 working days. Payment is processed within 5 working days. Completed forms can be faxed to 515-281-4825.
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R8/06 6/75 Form RE124
IOWA BOARD OF NURSING
RIVERPOINT BUSINESS PARK 400 SW 8TH ST SUITE B DES MOINES, IA 50309-4685
PURCHASE OF ROSTER ORDER FORM If you wish to purchase a roster of Iowa nurses, please complete the information requested below and return it to the Iowa Board of Nursing with the signed Purchase of Roster Agreement. 1. Type of roster: [ ] Labels [ ] List [ ] Diskette or [ ] CD — variable field length, comma separated values [ ] Diskette or [ ] CD — fixed field length [ ] Electronic file via E-mail (Variable field length, comma separated values unless otherwise specified.) 2. Type and status of license: [ ] Registered Nurses - Active (Inactive RNs/LPNs/ARNPs are available, but [ ] Licensed Practical Nurses - Active data includes outdated addresses and records [ ] ARNPs - Active for persons now deceased.) Indicate ARNP specialty areas: _________________________________________ (Note: ARNPs must also hold RN licenses, so will automatically appear in any list of active RNs) 3. Geographic area: [ ] Entire State of Iowa [ ] All out-of-state residents holding an Iowa license [ ] Specific Iowa counties (Attach list of counties, including county numbers if possible, i.e., Polk is county number 77) [ ] Specific states other than Iowa (attach list) 4. Printing sequence: [ ] Zip code [ ] Alphabetical by last name of licensee Above sequence applies to: [ ] Entire order as a whole [ ] Each county separately [ ] RNs and LPNs sorted separately within same roster [ ] RNS and LPNs in separate rosters or datasets (will not eliminate duplicate records) 5. Additional specifications for record selection (Optional) [ ] Practice areas _____________________________________________________ [ ] Educational level ___________________________________________________ [ ] Age range. Born after ____________________ and before _________________ [ ] Random selection. Quantity: _________________________ Please use additional sheets for any additional specifications you might have that are not listed.
6/75 R5/28/04 RE125
IOWA BOARD OF NURSING
RIVERPOINT BUSINESS PARK 400 SW 8TH ST SUITE B DES MOINES, IA 50309-4685
PURCHASE OF ROSTER AGREEMENT By signing this form: (1) I certify that the roster procured from the Iowa Board of Nursing, shall not be used in any manner which could be construed by the public to mean that the Iowa Board of Nursing or any of its employees supports, endorses, approves, etc., the materials being disseminated or the purchasing organization/individual, unless that organization/individual holds an Iowa Board of Nursing approved provider number for continuing nursing education. I acknowledge that I am placing an actual order for a roster of Iowa nurse licensees, for which I shall be responsible to assure payment is made within 30 days of receiving an invoice for said roster.
(2)
NAME (TYPED OR PRINTED):__________________________________________ TITLE: _____________________________________________________________
AGENCY/INSTITUTION/COMPANY NAME: ____________________________________________________________________
MAILING ADDRESS: ________________________________________________________ ________________________________________________________
E-MAIL ADDRESS: __________________________________________________ PHONE: ___________________________________________________________
SIGNATURE:________________________________________
DATE:______________________
PLEASE ATTACH THIS FORM TO THE PURCHASE OF ROSTER ORDER FORM BEING RETURNED TO THE IOWA BOARD OF NURSING. YOUR ORDER CANNOT BE PROCESSED WITHOUT A SIGNATURE ON THIS FORM.
RE126 6/75 R 5/2004
IOWA BOARD OF NURSING RIVERPOINT BUSINESS PARK 400 SW 8TH ST SUITE B DES MOINES, IA 50309-4685
COST INFORMATION
ELECTRONIC MEDIA (E-mail, diskette, or CD) Flat fee per data set This charge can be pre-paid. Additional note: A format sheet will be included with electronic rosters. However, the Board office has only limited ability to supply additional technical assistance in importing this data into your PC software. $40.00
HARD COPY MEDIA Set up fee Pressure sensitive labels Hard copy printed list $25.00 $14.50/thousand records printed $5.00/thousand records printed
Because the charge for labels or lists is based on the number of records in the data set, the cost cannot be known until the order has been processed and a record-count can be obtained. Therefore, orders for hard copy media cannot be pre-paid.
MIXED FORMATS If data sets are ordered on both hard copy and electronic media simultaneously, the charge shall include both the $40 for the electronic format, and the cost per thousand for the printed format.
R8/2006 8/04 RE001
08/09/2006
Iowa Board of Nursing
Total Nurses In County
171 66
64 26
236 83
102 47 143 72
113 44
80 30
116 51
115 45
236 78
183 71
Top # - Registered Nurse Bottom # - Licensed Practical Nurse
402 140
172 78
214 89
150 63
118 44
645 176
221 78
163 69 184 101 213 73
355 83
190 79
195 56
95 50
149 48
171 53
114 43
192 106
311 97
1440 375
90 31
150 53
189 60
613 154
228 51
278 105
164 64
1332 596
265 138
201 61
1390 333
131 63
130 97
284 141
147 41
356 111
828 183
449 248
175 106
271 110
2472 541
189 63
219 48
574 129 240 55
229 69
185 82
82 56
143 39
539 101
5217 710
391 90
175 77
219 62
2566 195
1889 295
343 90 189 48 539 107 467 117 201 80 178 54 343 74
1070 335
153 77
63 35
107 41 231 69
Out Of State
3223 649 525 190
229 83
151 76
58 32
155 95
84 44
89 57
107 57
412 132
141 49
85 67
195 132
82 56
71 28
77 40
66 54
133 112
128 55
93 31
393 161