JCAHPO Application for Examination
9 . Release of Examination Data
JCAHPO reserves the right to use , for any purpose , all examination data in aggregate reports related to exam performance . Release of such data will not include names or personal , identifiable information . Examples of the purposed , for which such data might be used include , but are not limited to : JCAHPO research projects , grants , and formal training program reports .
Information regarding whether or not you are actively certified is public and may be verified or accessed by anyone .
If you wish to authorize JCAHPO ’ s release of your individual , identifiable data ( name ) to any source , please contact JCAHPO , in writing , with the name of the intended recipient and the time period in which release can be made .
Compliance with the Americans with Disabilities Act ( ADA ) In compliance with the ADA , JCAHPO will provide reasonable accommodations for candidates with disabilities who cannot take the examination under the usual testing conditions . Disabled individuals must provide notice and appropriate documentation ( at the applicant ’ s expense ) of their disability when applying for the examination .
If accommodations are necessary for you to complete a JCAHPO examination due to functional limitations imposed by a disability , you will be required to complete and return a questionnaire . Questionnaires must be submitted with proper documentation and included with the examination application .
Application Checklist Before mailing your application , please be sure that the following have been included : o A copy of documentation showing successful completion of a formal educational training program or independent study course , if applicable . o A copy of verification of college credits or JCAHPO continuing education credits , if applicable .
o OSA applicants only : A copy of a document showing official accreditation of the surgical facility by a nationally-recognized accrediting agency , if using the SA2 eligibility pathway .
o OSA applicants only : Case log of 15 observed category A surgeries if using the SA3 eligibility pathway . o Completion of the appropriate eligibility criteria box , question # 9 on section 6 , and your signature on application pages 1 and 2 .
o COA , COT , COMT , OSA , ROUB , and CDOS applicants : Your sponsor ’ s signature ( application page 3 of 4 ). Your sponsor must be an ophthalmologist If you are applying for the COA , COT , COMT , or OSA exam . ROUB and CDOS applicants may have any physician serve as their sponsor . Original signatures are required - signature stamps or computerized digitized signatures are not accepted .
o COT or COMT applicants : If using the T4 or TG5 eligibility pathway , verification of non-certified work experience from your ophthalmologist on letterhead .
o CCOA applicants only : Your supervisor ’ s signature ( application page 3 of 4 ). Original signatures are required - signature stamps or computerized digitized signatures are not accepted .
o CDOS applicants only : Case log of 20 abnormal ophthalmic B-scan examinations .
o Examination fee , payable to JCAHPO in U . S . dollars . ( Refer to fee schedule ). All applications denied due to not meeting the eligibility requirements or incomplete applications , will not receive a refund of the exam fee .
NOTE : Please retain a photocopy of your application . If any of the above-mentioned items are missing or incomplete , your application will not be processed . Mail ( DO NOT FAX ) your application to :
JCAHPO 2025 Woodlane Drive St . Paul , MN 55125-2998
Once your application is accepted , you will be assigned a 90-day eligibility period . You must schedule and take your examination during this period . This eligibility period , along with information on how to schedule your exam , will be provided to you in a confirmation letter you will receive after your application is accepted .
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