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District of Columbia Respiratory Therapy — Requirements & Free Practice

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Licenses, application pathways and examination requirements

Each license and applicant pathway has its own requirements and exemptions. Choosing practice questions does not determine your eligibility.

License to practice respiratory therapy

Ordinary District respiratory therapy license. CRT and RRT are alternative NBRC credentials for the same District license, not separate District license types.

Licensing authority: District of Columbia Board of Respiratory Care / DC Health · Application information

Licensure by endorsement
Therapist Multiple-Choice Examination
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Certification
Hold valid and current NBRC CRT or RRT certification under § 7605.1(c).
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Education Implementation
The current checklist item 7 also requests a CoARC-accredited program transcript; § 7602.1 expressly excepts § 7605 endorsement applicants from its educational requirement.
Examination Waiver
The Board may waive examination requirements under § 3-1205.06(e) for a qualifying reciprocity or endorsement applicant or a nationally certified person when the Mayor determines the examination equivalent. This discretion is an applicant condition; the current identified TMC remains referenced.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
Other License
Currently licensed in another state under standards substantially equivalent when licensed; remain continuously in good standing under standards the Board finds comparable.
Score Evidence
The current examination-and-endorsement checklist item 10 requests official NBRC passing scores, and item 13 requires verification directly from every jurisdiction where a professional license was ever held.
Expedited initial licensure review for protected conduct
Therapist Multiple-Choice Examination
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Education
Successfully complete a CoARC-accredited respiratory care program or a successor-accredited program; supply the official transcript directly from the issuing institution.
Examination Score
Receive the NBRC passing score on TMC at the CRT or RRT threshold. The two thresholds are alternatives within one examination, not two examinations; submit NBRC-certified or validated results.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
Protected Conduct
Expedited review under § 3-1205.01a applies when another jurisdiction suspended or revoked the applicant solely for conduct protected by § 3-1205.14(e-1), permitted in the District and within the District profession scope. This is expedited review of an application, not an exemption from ordinary education and examination qualifications.
Score Age
If the required examination was passed more than five years before applying, take and pass it again unless CRT or RRT credentials have been maintained continuously and were obtained after July 1, 2002 (§ 7604.3).
Reinstatement within five years after expiration
No examination is required for this applicant pathway.
Certification
Provide a current valid NBRC CRT or RRT credential under § 7606.4(b).
Competency
Meet current reinstatement requirements, pay the reinstatement fee, and prove fitness. If inactive in practice for more than two years, the Board may require training, testing, or monitoring under § 3-1205.12(c); this unnamed competency measure is an applicant condition, not a registered examination.
Continuing Education
Complete eight approved CEUs per expired year; two required CEUs in ethics and ten percent of total continuing education in District public-health priorities under § 7606.4(a).
Prior License
Apply within five years after the District license expired; beyond five years a new application is required.

Official no-examination sources

Effective from 2026-09-22.

First renewal after initial licensure
No examination is required for this applicant pathway.
Continuing Education
The first renewal after initial grant is exempt from § 7606 continuing education under § 7606.2.
National Certification
Continuously maintain valid NBRC certification; certification status is a condition, not an instruction to retake an examination.
Renewal Application
Submit the prescribed online renewal, required fees, supporting documents and applicable criminal background check.
Term
The Director changed issuance and renewal to the last day of the holder birth month for licenses issued on or after June 16, 2024; use the expiration shown on the license.

Official no-examination sources

Effective from 2026-09-22.

Licensure by examination: foreign educated applicant
Therapist Multiple-Choice Examination
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Education
Successfully complete a CoARC-accredited respiratory care program or a successor-accredited program; supply the official transcript directly from the issuing institution.
Examination Score
Receive the NBRC passing score on TMC at the CRT or RRT threshold. The two thresholds are alternatives within one examination, not two examinations; submit NBRC-certified or validated results.
Foreign Education
Under § 7603.1, foreign-educated applicants must meet § 7602; § 3-1205.03(b) permits Board evaluation of substantial equivalence.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
National Certification Waiver
The Board may waive examination requirements under § 3-1205.06(e) for a qualifying reciprocity or endorsement applicant or a nationally certified person when the Mayor determines the examination equivalent. This discretion is an applicant condition; the current identified TMC remains referenced.
Score Age
If the required examination was passed more than five years before applying, take and pass it again unless CRT or RRT credentials have been maintained continuously and were obtained after July 1, 2002 (§ 7604.3).
Placement on inactive status
No examination is required for this applicant pathway.
Fee
Pay the inactive-status fee.
Practice
No practice, attempted practice, or offer to practice while inactive; renewal fees do not apply under § 3-1205.11(b).
Prior License
Hold the District respiratory therapy license and request inactive status.

Official no-examination sources

Effective from 2026-09-22.

Licensure by examination
Therapist Multiple-Choice Examination
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Education
Successfully complete a CoARC-accredited respiratory care program or a successor-accredited program; supply the official transcript directly from the issuing institution.
Examination Score
Receive the NBRC passing score on TMC at the CRT or RRT threshold. The two thresholds are alternatives within one examination, not two examinations; submit NBRC-certified or validated results.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
National Certification Waiver
The Board may waive examination requirements under § 3-1205.06(e) for a qualifying reciprocity or endorsement applicant or a nationally certified person when the Mayor determines the examination equivalent. This discretion is an applicant condition; the current identified TMC remains referenced.
Score Age
If the required examination was passed more than five years before applying, take and pass it again unless CRT or RRT credentials have been maintained continuously and were obtained after July 1, 2002 (§ 7604.3).
Late renewal within sixty days
No examination is required for this applicant pathway.
Continuing Education
Normally sixteen approved CEUs in the preceding two years: two ethics, two LGBTQ, and ten percent District public-health priorities under § 7606.5(b). Board-approved CE credit, audits, exemptions and variance remain applicant conditions under §§ 7607, 7606.7 and 4018.
Late Period
Renew within sixty days of expiration and pay the late fee under § 4005.5; timely late renewal deems the license valid during the intervening period.
National Certification
Continuously maintain valid NBRC certification; certification status is a condition, not an instruction to retake an examination.
Renewal Application
Submit the prescribed online renewal, required fees, supporting documents and applicable criminal background check.
Term
The Director changed issuance and renewal to the last day of the holder birth month for licenses issued on or after June 16, 2024; use the expiration shown on the license.

Official no-examination sources

Effective from 2026-09-22.

Special reinstatement after active military deployment
No examination is required for this applicant pathway.
Certification
Provide a current valid NBRC CRT or RRT credential.
Competency
Satisfy current fitness and competency requirements; unnamed Board-directed testing remains an applicant condition.
Continuing Education
Comply with § 7606.4 and any CE timing relief in § 4015.2.
Deployment
Apply while in service or no later than six months after discharge or return to inactive military status; provide activation orders or other proof and pay the renewal fee.
Fee Relief
Reinstatement and late-renewal fees are waived under § 4015.1.
Prior License
License was active at deployment and lapsed during active military operations; the five-year statutory reinstatement limit still applies.

Official no-examination sources

Effective from 2026-09-22.

Special renewal after active military deployment
No examination is required for this applicant pathway.
Continuing Education
Normally sixteen approved CEUs in the preceding two years: two ethics, two LGBTQ, and ten percent District public-health priorities under § 7606.5(b). Board-approved CE credit, audits, exemptions and variance remain applicant conditions under §§ 7607, 7606.7 and 4018.
Continuing Education Deadline
Deficient CE must be completed within six months after discharge, return to inactive military status, or return from an active war zone; CE cannot be reused for the next renewal and next-cycle requirements are not prorated.
Deployment
License was active when deployed during United States active military operations; apply while in service or within six months of discharge or return to inactive military status, provide activation orders or other proof and pay the renewal fee.
Fee Relief
Reinstatement or late-renewal fee is waived under § 4015.1.
National Certification
Continuously maintain valid NBRC certification; certification status is a condition, not an instruction to retake an examination.
Renewal Application
Submit the prescribed online renewal, required fees, supporting documents and applicable criminal background check.
Term
The Director changed issuance and renewal to the last day of the holder birth month for licenses issued on or after June 16, 2024; use the expiration shown on the license.

Official no-examination sources

Effective from 2026-09-22.

New application more than five years after emeritus status
Therapist Multiple-Choice Examination
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Education
Successfully complete a CoARC-accredited respiratory care program or a successor-accredited program; supply the official transcript directly from the issuing institution.
Examination Score
Receive the NBRC passing score on TMC at the CRT or RRT threshold. The two thresholds are alternatives within one examination, not two examinations; submit NBRC-certified or validated results.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
Prior Status
§ 3-1205.11a(f) requires a new license application and current competency after more than five years in emeritus status. This conditional return provision does not establish that the Board currently offers emeritus entry.
Score Age
If the required examination was passed more than five years before applying, take and pass it again unless CRT or RRT credentials have been maintained continuously and were obtained after July 1, 2002 (§ 7604.3).
New application after more than five years of expiration
Therapist Multiple-Choice Examination
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Competency
Establish current competency; any unnamed Board-directed additional testing, training, or monitoring is an applicant condition.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Education
Successfully complete a CoARC-accredited respiratory care program or a successor-accredited program; supply the official transcript directly from the issuing institution.
Examination Score
Receive the NBRC passing score on TMC at the CRT or RRT threshold. The two thresholds are alternatives within one examination, not two examinations; submit NBRC-certified or validated results.
Expiration
After five years, § 3-1205.12(b) prohibits reinstatement and requires qualification through a new application.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
Score Age
If the required examination was passed more than five years before applying, take and pass it again unless CRT or RRT credentials have been maintained continuously and were obtained after July 1, 2002 (§ 7604.3).
Reactivation from inactive status
No examination is required for this applicant pathway.
Certification
Under § 7606.3, hold valid and active NBRC CRT or RRT credentials; the requirement is credential maintenance, not a new examination attempt.
Competency
Under § 3-1205.11(c), satisfy current CE and criminal-background-check requirements and establish competency, including any applicable re-entry plan. No separately identifiable examination is assigned by these provisions.
Continuing Education
Normally sixteen approved CEUs in the preceding two years: two ethics, two LGBTQ, and ten percent District public-health priorities under § 7606.5(b). Board-approved CE credit, audits, exemptions and variance remain applicant conditions under §§ 7607, 7606.7 and 4018.
National Certification
Continuously maintain valid NBRC certification; certification status is a condition, not an instruction to retake an examination.
Prior Status
Hold an inactive respiratory therapy license and seek reactivation.
Renewal Application
Submit the prescribed online renewal, required fees, supporting documents and applicable criminal background check.
Term
The Director changed issuance and renewal to the last day of the holder birth month for licenses issued on or after June 16, 2024; use the expiration shown on the license.

Official no-examination sources

Effective from 2026-09-22.

Licensure by reciprocity
Therapist Multiple-Choice Examination
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Board Assessment
The Board may interview the applicant and assess education, training and character under § 4014.4; no separate named examination is assigned by this interview provision.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Examination Waiver
The Board may waive examination requirements under § 3-1205.06(e) for a qualifying reciprocity or endorsement applicant or a nationally certified person when the Mayor determines the examination equivalent. This discretion is an applicant condition; the current identified TMC remains referenced.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
Other License
Hold a license and good standing in a jurisdiction with substantially equivalent requirements at licensure, which admits District licensees in like manner; provide the proof in § 4014.1.
Subsequent renewal
No examination is required for this applicant pathway.
Continuing Education
Normally sixteen approved CEUs in the preceding two years: two ethics, two LGBTQ, and ten percent District public-health priorities under § 7606.5(b). Board-approved CE credit, audits, exemptions and variance remain applicant conditions under §§ 7607, 7606.7 and 4018.
National Certification
Continuously maintain valid NBRC certification; certification status is a condition, not an instruction to retake an examination.
Renewal Application
Submit the prescribed online renewal, required fees, supporting documents and applicable criminal background check.
Term
The Director changed issuance and renewal to the last day of the holder birth month for licenses issued on or after June 16, 2024; use the expiration shown on the license.

Official no-examination sources

Effective from 2026-09-22.

First application with temporary supervised practice authorization
Therapist Multiple-Choice Examination
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Authorization
Do not begin practice until express written Board authorization after satisfactory review of FBI background-check results.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Education
Successfully complete a CoARC-accredited respiratory care program or a successor-accredited program; supply the official transcript directly from the issuing institution.
Examination Score
Receive the NBRC passing score on TMC at the CRT or RRT threshold. The two thresholds are alternatives within one examination, not two examinations; submit NBRC-certified or validated results.
Form Discrepancy
The Board-linked supervised practice form cites older § 7608.6-.7 and states one issuance only. Current § 7608.3 requires Board authorization and expressly permits extension for good cause; current rule governs.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
Pending Application
The first District application has been filed and the decision is pending (§ 7608.1(b)); this is supervised authorization pending the ordinary license, not a separate license identity.
Supervision
Practice under general supervision of a District-licensed respiratory therapist, who is responsible for the applicant practice.
Term
Authorization may last no more than ninety days; the Board may extend it for good cause under § 7608.3(c).
Voluntary limitation of an existing license
No examination is required for this applicant pathway.
Board Conditions
The Board may require treatment, counseling, prescribed education, or supervised practice under § 3-1205.18(a)(3); these are applicant conditions.
Practice
Do not engage in the practices or activities covered by the limitation.
Prior License
Hold a District respiratory therapy license and agree with the Board to permanent, indefinite, or fixed-period limitation.

Official no-examination sources

Effective from 2026-09-22.

Provisional license to practice respiratory therapy

Provisional reciprocity license, not exceeding ninety days, when only formal evidence of the other jurisdiction license is outstanding and the Board independently confirms good standing.

Licensing authority: District of Columbia Board of Respiratory Care / DC Health · Application information

Provisional issuance while reciprocity proof is pending
Therapist Multiple-Choice Examination
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Board Discretion
The Board must independently confirm good standing by telephone or other means and may grant provisional issuance for no more than ninety days under § 4014.5.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Examination Waiver
The Board may waive examination requirements under § 3-1205.06(e) for a qualifying reciprocity or endorsement applicant or a nationally certified person when the Mayor determines the examination equivalent. This discretion is an applicant condition; the current identified TMC remains referenced.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
Reciprocity
Meet reciprocity requirements and all other license requirements; only formal receipt of the required other-jurisdiction license certification is outstanding.

Temporary license to practice respiratory therapy

A temporary form of the respiratory therapy license, subject to a written Director determination, prior licensure in good standing under controlling § 3-1205.08a, Board restrictions, and a term not exceeding ninety days.

Licensing authority: District of Columbia Board of Respiratory Care / DC Health · Application information

Temporary issuance pending endorsement
Therapist Multiple-Choice Examination
Applicant Category
Licensed in another United States jurisdiction and applying for endorsement; also meet the controlling § 3-1205.08a requirement for active prior licensure in good standing.
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Director Determination
Issuance depends on the Director written necessity determination and the Board discretion; there is no promise of automatic issuance.
Examination Waiver
The Board may waive examination requirements under § 3-1205.06(e) for a qualifying reciprocity or endorsement applicant or a nationally certified person when the Mayor determines the examination equivalent. This discretion is an applicant condition; the current identified TMC remains referenced.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
Permanent Application
The TMC reference is the examination involved in the associated ordinary license application; passing it need not precede temporary issuance.
Term
No more than ninety days; practice is subject to Board restrictions.
Temporary issuance for an already licensed new applicant
Therapist Multiple-Choice Examination
Applicant Category
Submit a new license application and hold a license in good standing in another jurisdiction under § 4007.4(c) and controlling § 3-1205.08a; prior foreign or other-jurisdiction examinations are applicant evidence, not District examination leaves.
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Director Determination
Issuance depends on the Director written necessity determination and the Board discretion; there is no promise of automatic issuance.
Examination Waiver
The Board may waive examination requirements under § 3-1205.06(e) for a qualifying reciprocity or endorsement applicant or a nationally certified person when the Mayor determines the examination equivalent. This discretion is an applicant condition; the current identified TMC remains referenced.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
Permanent Application
The TMC reference is the examination involved in the associated ordinary license application; passing it need not precede temporary issuance.
Term
No more than ninety days; practice is subject to Board restrictions.
Temporary issuance pending the next examination
Therapist Multiple-Choice Examination
Applicant Category
Meet all ordinary license qualifications except successful examination completion and apply for the next examination under § 4007.4(b); the later controlling § 3-1205.08a additionally requires licensure in good standing in another jurisdiction.
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Director Determination
Issuance depends on the Director written necessity determination and the Board discretion; there is no promise of automatic issuance.
Examination Waiver
The Board may waive examination requirements under § 3-1205.06(e) for a qualifying reciprocity or endorsement applicant or a nationally certified person when the Mayor determines the examination equivalent. This discretion is an applicant condition; the current identified TMC remains referenced.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
Permanent Application
The TMC reference is the examination involved in the associated ordinary license application; passing it need not precede temporary issuance.
Term
No more than ninety days; practice is subject to Board restrictions.
Temporary issuance pending reciprocity
Therapist Multiple-Choice Examination
Applicant Category
Licensed in another United States jurisdiction and applying for reciprocity; also meet the controlling § 3-1205.08a requirement for active prior licensure in good standing.
Application
Submit a complete online application, required fees and supporting documents; screening and Clean Hands yes responses require explanations and relevant records.
Criminal History
Meet the occupation-related conviction and licensure-discipline qualifications in § 3-1205.03(a); submit the criminal background check required by § 3-1205.22 and checklist item 11.
Director Determination
Issuance depends on the Director written necessity determination and the Board discretion; there is no promise of automatic issuance.
Examination Waiver
The Board may waive examination requirements under § 3-1205.06(e) for a qualifying reciprocity or endorsement applicant or a nationally certified person when the Mayor determines the examination equivalent. This discretion is an applicant condition; the current identified TMC remains referenced.
Identity
Provide photograph, government photo identification, legal name-change documents if applicable, and the social-security-number affidavit and listed identity document if no social security number exists.
Minimum Age
At least 18 years old under D.C. Code § 3-1205.03(a)(2).
National Certification
Maintain valid NBRC national certification continuously while licensed under 17 DCMR § 7611.1.
Permanent Application
The TMC reference is the examination involved in the associated ordinary license application; passing it need not precede temporary issuance.
Term
No more than ninety days; practice is subject to Board restrictions.

Therapist Multiple-Choice Examination

Provider
The National Board for Respiratory Care (NBRC); administered Monday through Saturday at more than 300 assessment centers through the NBRC testing agency PSI
Format
Computer-based multiple-choice examination; each scored item is linked to a content area and cognitive level (recall, application, analysis); the TMC ends December 31, 2026 and the Respiratory Therapy Examination is used from January 1, 2027
Exam questions
160 multiple-choice items: 140 scored and 20 pretest
Time limit
3 hours
Passing score
Raw score (each item worth one point) compared with two cut scores: the low cut score earns the CRT credential; the high cut score earns the CRT credential and eligibility for the Clinical Simulation Examination for candidates eligible to earn the RRT
Exam fee
$190 new applicants; $150 repeat applicants
Examination outline
  • I. PATIENT DATA (50 of 140 scored items; Recall 15, Application 27, Analysis 8) (35.71%)
    • I.A. Evaluate Data in the Patient Record (10 of 50 section items; Recall 4, Application 6, Analysis 0) — 1. Patient history, for example, history of present illness (HPI), orders, medication reconciliation, progress notes, DNR status / advance directives, social, family, and medical history; 2. Physical examination relative to the cardiopulmonary system; 3. Lines, drains, and airways, for example, chest tube, vascular lines, artificial airway; 4. Laboratory results, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 5. Blood gas analysis and / or hemoximetry (CO-oximetry) results; 6. Pulmonary function testing results, for example spirometry, lung volumes, DLCO; 7. 6-minute walk test results; 8. Imaging study results, for example, chest radiograph, CT scan, ultrasonography and / or echocardiography, PET scan, ventilation / perfusion scan; 9. Maternal and perinatal / neonatal history, for example, APGAR scores, gestational age, L / S ratio; 10. Sleep study results, for example, apnea-hypopnea index (AHI); 11. Trends in monitoring results: a. fluid balance; b. vital signs; c. intracranial pressure; d. ventilator liberation parameters; e. pulmonary mechanics; f. noninvasive, for example, pulse oximetry, capnography, transcutaneous; g. cardiac evaluation / monitoring results, for example, ECG, hemodynamic parameters; 12. Determination of a patient's pathophysiological state
    • I.B. Perform Clinical Assessment (10 of 50 section items; Recall 3, Application 6, Analysis 1) — 1. Interviewing a patient to assess a. level of consciousness and orientation, emotional state, and ability to cooperate; b. level of pain; c. shortness of breath, sputum production, and exercise tolerance; d. smoking history; e. environmental exposures; f. activities of daily living; g. learning needs, for example, literacy, preferred learning style, social / cultural; 2. Performing inspection to assess a. general appearance; b. characteristics of the airway, for example, patency, Mallampati classification, tracheal shift; c. cough, sputum amount and character; d. status of a neonate, for example, APGAR score, gestational age; e. skin integrity, for example, pressure ulcers, stoma site; 3. Palpating to assess a. pulse, rhythm, intensity; b. accessory muscle activity; c. asymmetrical chest movements, tactile fremitus, crepitus, tenderness, tactile rhonchi, and / or tracheal deviation; 4. Performing diagnostic chest percussion; 5. Auscultating to assess a. breath sounds; b. heart sounds and rhythm; c. blood pressure; 6. Reviewing a chest radiograph to assess a. quality of imaging, for example, patient positioning, penetration, lung inflation; b. presence and position of airways, lines, and drains; c. presence of foreign bodies; d. heart size and position; e. presence of, or change in, (i) cardiopulmonary abnormalities, for example, pneumothorax, consolidation, pleural effusion, pulmonary edema, pulmonary artery size; (ii) diaphragm, mediastinum, and / or trachea
    • I.C. Perform Procedures to Gather Clinical Information (12 of 50 section items; Recall 4, Application 7, Analysis 1) — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas sample collection; 6. Blood gas analysis and / or hemoximetry (CO-oximetry); 7. Oxygen titration with exercise; 8. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 9. Hemodynamic monitoring; 10. Pulmonary compliance and airways resistance; 11. Plateau pressure; 12. Auto-PEEP determination; 13. Spontaneous breathing trial (SBT); 14. Apnea monitoring; 15. Apnea test (brain death determination); 16. Overnight pulse oximetry; 17. CPAP / NPPV titration during sleep; 18. Cuff management, for example, tracheal, laryngeal; 19. Sputum induction; 20. Cardiopulmonary stress testing; 21. 6-minute walk test; 22. Spirometry outside or inside a pulmonary function laboratory; 23. DLCO inside a pulmonary function laboratory; 24. Lung volumes inside a pulmonary function laboratory; 25. Tests of respiratory muscle strength - MIP and MEP; 26. Therapeutic bronchoscopy
    • I.D. Evaluate Procedure Results (10 of 50 section items; Recall 2, Application 4, Analysis 4) — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas analysis and / or hemoximetry (CO-oximetry); 6. Oxygen titration with exercise; 7. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 8. Hemodynamic monitoring; 9. Pulmonary compliance and airways resistance; 10. Plateau pressure; 11. Auto-PEEP; 12. Spontaneous breathing trial (SBT); 13. Apnea monitoring; 14. Apnea test (brain death determination); 15. Overnight pulse oximetry; 16. CPAP / NPPV titration during sleep; 17. Cuff status, for example, laryngeal, tracheal; 18. Cardiopulmonary stress testing; 19. 6-minute walk test; 20. Spirometry outside or inside a pulmonary function laboratory; 21. DLCO inside a pulmonary function laboratory; 22. Lung volumes inside a pulmonary function laboratory; 23. Tests of respiratory muscle strength - MIP and MEP
    • I.E. Recommend Diagnostic Procedures (8 of 50 section items; Recall 2, Application 4, Analysis 2) — 1. Testing for tuberculosis; 2. Laboratory tests, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 3. Imaging studies; 4. Bronchoscopy a. diagnostic; b. therapeutic; 5. Bronchoalveolar lavage (BAL); 6. Pulmonary function testing; 7. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 8. Blood gas and/or hemoximetry (CO-oximetry); 9. ECG; 10. Exhaled gas analysis, for example, CO2, CO, FENO; 11. Hemodynamic monitoring; 12. Sleep studies; 13. Thoracentesis
  • II. TROUBLESHOOTING AND QUALITY CONTROL OF DEVICES, AND INFECTION CONTROL (20 of 140 scored items; Recall 8, Application 9, Analysis 3) (14.29%)
    • II.A. Assemble / Troubleshoot Devices (15 of 20 section items; Recall 4, Application 8, Analysis 3) — 1. Medical gas delivery interfaces, for example, mask, cannula, heated high-flow nasal cannula; 2. Long-term oxygen therapy; 3. Medical gas delivery, metering, and /or clinical analyzing devices, for example, concentrator, liquid system, flowmeter, regulator, gas cylinder, blender, air compressor, gas analyzers; 4. CPAP / NPPV with patient interfaces; 5. Humidifiers; 6. Nebulizers; 7. Metered-dose inhalers, spacers, and valved holding chambers; 8. Dry-powder inhalers (DPI); 9. Resuscitation equipment, for example, self-inflating resuscitator, flow-inflating resuscitator, AED; 10. Mechanical ventilators; 11. Intubation equipment; 12. Artificial airways; 13. Suctioning equipment, for example, regulator, canister, tubing, catheter; 14. Blood analyzers, for example, hemoximetry (CO-oximetry), point-of-care, blood gas; 15. Patient breathing circuits; 16. Hyperinflation devices; 17. Secretion clearance devices; 18. Heliox delivery device; 19. Portable spirometer; 20. Testing equipment in a pulmonary function laboratory; 21. Pleural drainage; 22. Noninvasive monitoring, for example, pulse oximeter, capnometer, transcutaneous; 23. Bronchoscopes and light sources; 24. Hemodynamic monitoring a. pressure transducers; b. catheters, for example, arterial, pulmonary artery
    • II.B. Ensure Infection Prevention (2 of 20 section items; Recall 2, Application 0, Analysis 0) — 1. Adhering to infection prevention policies and procedures, for example, Standard Precautions, donning/doffing, isolation; 2. Adhering to disinfection policies and procedures; 3. Proper handling of biohazardous materials
    • II.C. Perform Quality Control Procedures (3 of 20 section items; Recall 2, Application 1, Analysis 0) — 1. Blood analyzers; 2. Gas analyzers; 3. Pulmonary function equipment for testing a. spirometry results; b. lung volumes; c. diffusing capacity (DLCO); 4. Mechanical ventilators; 5. Noninvasive monitors
  • III. INITIATION AND MODIFICATION OF INTERVENTIONS (70 of 140 scored items; Recall 10, Application 30, Analysis 30) (50%)
    • III.A. Maintain a Patent Airway Including the Care of Artificial Airways (10 of 70 section items; Recall 3, Application 4, Analysis 3) — 1. Proper positioning of a patient; 2. Recognition of a difficult airway; 3. Establishing and managing a patient's airway a. nasopharyngeal airway; b. oropharyngeal airway; c. esophagealtracheal tubes / supraglottic airways; d. endotracheal tube; e. tracheostomy tube; f. laryngectomy tube; g. speaking valves; h. devices that assist with intubation, for example, endotracheal tube exchanger, video laryngoscopy; 4. Performing tracheostomy care; 5. Exchanging artificial airways; 6. Maintaining adequate humidification; 7. Initiating protocols to prevent ventilator-associated infections; 8. Performing extubation
    • III.B. Perform Airway Clearance and Lung Expansion Techniques (5 of 70 section items; Recall 2, Application 2, Analysis 1) — 1. Postural drainage, percussion, or vibration; 2. Suctioning, for example, nasotracheal, oropharyngeal; 3. Mechanical devices, for example, high-frequency chest wall oscillation, vibratory PEP, intrapulmonary percussive ventilation, insufflation / exsufflation; 4. Assisted cough, for example, huff, abdominal thrust; 5. Hyperinflation therapy; 6. Inspiratory muscle training
    • III.C. Support Oxygenation and Ventilation (15 of 70 section items; Recall 1, Application 5, Analysis 9) — 1. Initiating and adjusting oxygen therapy; 2. Minimizing hypoxemia, for example, patient positioning, secretion removal; 3. Initiating and adjusting mask or nasal CPAP; 4. Initiating and adjusting mechanical ventilation settings a. continuous mechanical ventilation; b. noninvasive ventilation; c. high-frequency ventilation; d. alarms; 5. Recognizing and correcting patient-ventilator dyssynchrony; 6. Utilizing ventilator graphics; 7. Performing lung recruitment maneuvers; 8. Liberating a patient from mechanical ventilation
    • III.D. Administer Medications and Specialty Gases (4 of 70 section items; Recall 1, Application 3, Analysis 0) — 1. Aerosolized preparations a. antimicrobials; b. pulmonary vasodilators; c. bronchodilators; d. mucolytics / proteolytics; e. steroids; 2. Endotracheal instillation; 3. Specialty gases, for example, heliox, inhaled NO
    • III.E. Ensure Modifications are Made to the Respiratory Care Plan (18 of 70 section items; Recall 1, Application 7, Analysis 10) — 1. Treatment termination, for example, life-threatening adverse event; 2. Recommendations a. starting treatment based on patient response; b. treatment of pneumothorax; c. adjustment of fluid balance; d. adjustment of electrolyte therapy; e. insertion or change of artificial airway; f. liberating from mechanical ventilation; g. extubation; h. discontinuing treatment based on patient response; i. consultation from a physician specialist; 3. Recommendations for changes a. patient position; b. oxygen therapy; c. humidification; d. airway clearance; e. hyperinflation; f. mechanical ventilation; 4. Recommendations for pharmacologic interventions a. bronchodilators; b. anti-inflammatory drugs; c. mucolytics and proteolytics; d. aerosolized antibiotics; e. inhaled pulmonary vasodilators; f. cardiovascular; g. antimicrobials; h. sedatives and hypnotics; i. analgesics; j. narcotic antagonists; k. benzodiazepine antagonists; l. neuromuscular blocking agents; m. diuretics; n. surfactants; o. changes to drug, dosage, administration frequency, mode, or concentration
    • III.F. Utilize Evidence-Based Practice (6 of 70 section items; Recall 0, Application 2, Analysis 4) — 1. Classification of disease severity; 2. Recommendations for changes in a therapeutic plan when indicated; 3. Application of guidelines, for example, ARDSNet, NAEPP, GOLD
    • III.G. Provide Respiratory Care in High-Risk Situations (5 of 70 section items; Recall 0, Application 2, Analysis 3) — 1. Emergency a. cardiopulmonary emergencies, excluding CPR; b. disaster management; c. medical emergency team (MET) / rapid response team; 2. Interprofessional communication; 3. Patient transport a. land / air between hospitals; b. within a hospital
    • III.H. Assist a Physician / Provider in Performing Procedures (4 of 70 section items; Recall 1, Application 3, Analysis 0) — 1. Intubation; 2. Bronchoscopy; 3. Specialized bronchoscopy, for example, endobronchial ultrasound (EBUS), navigational bronchoscopy (ENB); 4. Thoracentesis; 5. Tracheotomy; 6. Chest tube insertion; 7. Insertion of arterial or venous catheters; 8. Moderate (conscious) sedation; 9. Cardioversion; 10. Withdrawal of life support
    • III.I. Conduct Patient and Family Education (3 of 70 section items; Recall 1, Application 2, Analysis 0) — 1. Safety and infection control; 2. Home care and related equipment; 3. Lifestyle changes, for example, smoking cessation, exercise; 4. Pulmonary rehabilitation; 5. Disease / condition management, for example, asthma, COPD, CF, tracheostomy care, ventilator dependent
Examination sources