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Massachusetts Respiratory Therapy — Requirements & Free Practice

US-MA · License preparation

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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.

Limited Respiratory Therapist License

Limited supervised practice restricted to successfully completed curriculum; nonrenewable.

Licensing authority: Massachusetts Board of Respiratory Care · Application information

Reinstatement following surrender, suspension, or revocation of the limited credential
Therapist Multiple-Choice Examination
Current experience
Where relevant current experience is not shown, the Board may require additional CE, retaking and passing the CRT examination, or both. Its discretion is a condition, and the current Board definition of CRT examination and minutes identify TMC; no discontinued standalone CRT examination is emitted.
Decision
The Board may reinstate when it advances the public interest. A denial states its reasons; another petition is ordinarily permitted after one year unless directed otherwise.
Documents
Provide proof of compliance with all consent/order requirements; direct other-jurisdiction status verifications; detailed resume; reinstatement fee; applicable renewal/reinstatement questionnaire and renewal fee if expired; CE evidence; notarized recommendations from three people including an unencumbered licensed RT; and the required criminal-record attestation and supporting records.
Limited restrictions
Reinstatement remains subject to the original limited-license scope, supervision and termination rules; it does not create a renewable or indefinite limited license.
Loss of license
The license or limited permit was surrendered, suspended, or revoked pursuant to a consent agreement or final Board order; eligibility remains subject to the agreement or order, including any permanent-surrender prohibition.
Petition
After meeting all reinstatement conditions, submit a dated, signed original petition with the statements and documentation required by RC-10-01.
Petition validity
A complete petition with fees is valid for 60 days; all required documentation must arrive within that period or a new petition with fees is needed.
Statements
Describe the loss of license, intervening professional and personal activities, remedial activities, practice and representations since loss, reasons for favorable action, future compliance plans, and all other professional licenses; attest under penalties of perjury that the submission is true.
Supervision and appearance
The Board may require probationary supervised practice and personal appearance in connection with the petition.
Limited licensure for a graduate
No examination is required for this applicant pathway.
Application
Submit a complete, signed application with required supporting documentation.
Application fee
The current initial limited license application fee is $150 unless waived.
Completed curriculum
Provide school-sealed Verification of Education signed by the program director, showing the completed curriculum; the application page requires at least two completed semesters.
Cori
Submit a signed and notarized CORI Acknowledgement Form.
Education
A graduate of a Board-approved respiratory care program; the license cannot continue beyond one year after graduation.
Exam eligibility
Be eligible to sit the licensure examination. A passing score is not an issuance condition in 261 CMR 3.07(1).
Expiration
Expires on full initial licensure, notification of an examination failure, or one year after graduation, whichever occurs first. Report a failure immediately to the Board and cease practice. The limited license is not renewable.
Fee
Pay the prescribed application fee unless a statutory waiver applies.
History disclosures
For affirmative professional or criminal history responses, submit an explanatory personal statement and all supporting documents.
Minimum age
At least 18 years old.
Moral character
Good moral character satisfactory to the Board.
Other licenses
Each relevant jurisdiction must send official verification of any professional license held now or previously directly to the Board.
Photo
Submit a 2x2 passport-style color photo with a white or off-white background.
Self query
Submit an unmodified National Practitioner Data Bank self-query.
Supervision
Practice only under a licensed respiratory therapist's supervision and only in services whose corresponding curriculum has been completed.
Transcripts
Educational institutions send official transcripts for CoARC-accredited respiratory care programs directly to the Board.

Official no-examination sources

Effective from 2026-09-22.

  • rule3.pdf

    261 CMR 3.07(1), limited license eligibility and application

  • rule3.pdf

    261 CMR 3.07(2)-(4), supervision and termination

  • limited.html

    What you need, education verification

  • limited.html

    What you need, self-query, CORI, other licenses and disclosures

  • rule3.pdf

    261 CMR 3.08, renewal requirements and nonrenewability of limited licenses

Limited licensure for a student
No examination is required for this applicant pathway.
Application
Submit a complete, signed application with required supporting documentation.
Application fee
The current initial limited license application fee is $150 unless waived.
Completed curriculum
Provide school-sealed Verification of Education signed by the program director, showing the completed curriculum; the application page requires at least two completed semesters.
Cori
Submit a signed and notarized CORI Acknowledgement Form.
Education
Currently enrolled in a Board-approved respiratory care program.
Exam eligibility
Be eligible to sit the licensure examination. A passing score is not an issuance condition in 261 CMR 3.07(1).
Expiration
Expires on full initial licensure, notification of an examination failure, or one year after graduation, whichever occurs first. Report a failure immediately to the Board and cease practice. The limited license is not renewable.
Fee
Pay the prescribed application fee unless a statutory waiver applies.
History disclosures
For affirmative professional or criminal history responses, submit an explanatory personal statement and all supporting documents.
Minimum age
At least 18 years old.
Moral character
Good moral character satisfactory to the Board.
Other licenses
Each relevant jurisdiction must send official verification of any professional license held now or previously directly to the Board.
Photo
Submit a 2x2 passport-style color photo with a white or off-white background.
Self query
Submit an unmodified National Practitioner Data Bank self-query.
Supervision
Practice only under a licensed respiratory therapist's supervision and only in services whose corresponding curriculum has been completed.
Transcripts
Educational institutions send official transcripts for CoARC-accredited respiratory care programs directly to the Board.

Official no-examination sources

Effective from 2026-09-22.

  • rule3.pdf

    261 CMR 3.07(1), limited license eligibility and application

  • rule3.pdf

    261 CMR 3.07(2)-(4), supervision and termination

  • limited.html

    What you need, education verification

  • limited.html

    What you need, self-query, CORI, other licenses and disclosures

  • rule3.pdf

    261 CMR 3.08, renewal requirements and nonrenewability of limited licenses

Restoration of the limited license after rescission of summary suspension
No examination is required for this applicant pathway.
Board final decision
The Board concludes that practice does not present an immediate and serious threat or that summary suspension is unnecessary to prevent the threat.
Original limits
The restored license retains any applicable original limited-license restrictions or expiration.
Restored status
The Board rescinds the summary suspension and restores exactly the preceding license status; no examination is prescribed by 261 CMR 4.05(5)(c).

Official no-examination sources

Effective from 2026-09-22.

  • rule4.pdf

    261 CMR 4.05(5)(c), rescission and restoration

Respiratory Therapist License

Ordinary license to practice respiratory care; statutory supervised practice while awaiting results is a privilege under section 23T, not a separately issued license.

Licensing authority: Massachusetts Board of Respiratory Care · Application information

Reinstatement following surrender, suspension, or revocation of the ordinary credential
Therapist Multiple-Choice Examination
Current experience
Where relevant current experience is not shown, the Board may require additional CE, retaking and passing the CRT examination, or both. Its discretion is a condition, and the current Board definition of CRT examination and minutes identify TMC; no discontinued standalone CRT examination is emitted.
Decision
The Board may reinstate when it advances the public interest. A denial states its reasons; another petition is ordinarily permitted after one year unless directed otherwise.
Documents
Provide proof of compliance with all consent/order requirements; direct other-jurisdiction status verifications; detailed resume; reinstatement fee; applicable renewal/reinstatement questionnaire and renewal fee if expired; CE evidence; notarized recommendations from three people including an unencumbered licensed RT; and the required criminal-record attestation and supporting records.
Loss of license
The license or limited permit was surrendered, suspended, or revoked pursuant to a consent agreement or final Board order; eligibility remains subject to the agreement or order, including any permanent-surrender prohibition.
Petition
After meeting all reinstatement conditions, submit a dated, signed original petition with the statements and documentation required by RC-10-01.
Petition validity
A complete petition with fees is valid for 60 days; all required documentation must arrive within that period or a new petition with fees is needed.
Statements
Describe the loss of license, intervening professional and personal activities, remedial activities, practice and representations since loss, reasons for favorable action, future compliance plans, and all other professional licenses; attest under penalties of perjury that the submission is true.
Supervision and appearance
The Board may require probationary supervised practice and personal appearance in connection with the petition.
Initial licensure by NBRC credential
Application
Submit a complete, signed application with required supporting documentation.
Board application demand
National Board of Respiratory Care (NBRC) documentation of certification. You must have obtained a passing score on NBRC’s CCRT examination. NBRC must send the documentation directly to the Board.
Cori
Submit a signed and notarized CORI Acknowledgement Form.
Fee
Pay the prescribed application fee unless a statutory waiver applies.
History disclosures
For affirmative professional or criminal history responses, submit an explanatory personal statement and all supporting documents.
Minimum age
At least 18 years old.
Moral character
Good moral character satisfactory to the Board.
National credential
Provide evidence satisfactory to the Board of an NBRC CRT or RRT credential. Currently offered TMC, or TMC and CSE for RRT, are references even when already passed. Predecessor examination scores and preexisting credentials can satisfy the condition without a new sitting.
New sitting waiver
Section 23U authorizes licensure without a new examination and 261 CMR 3.06(3) implements acceptance of an existing credential; the leaves describe currently offered examinations involved in that accepted credential.
Other licenses
Each relevant jurisdiction must send official verification of any professional license held now or previously directly to the Board.
Photo
Submit a 2x2 passport-style color photo with a white or off-white background.
Self query
Submit an unmodified National Practitioner Data Bank self-query.
Transcripts
Educational institutions must send complete official transcripts directly to the Board, identifying the degree and conferral date.
Initial licensure on Board recognized equivalent qualifications
Application
Submit a complete, signed application with required supporting documentation.
Board equivalence
M.G.L. c.112, section 23U permits the Board to license a therapist who demonstrates that Massachusetts licensing requirements have been met or exceeded. The Board decides the equivalence and whether to exercise the permission to license without a new examination.
Cori
Submit a signed and notarized CORI Acknowledgement Form.
Current application requirement
The general current application requires direct NBRC certification and a passing CRT examination score. TMC remains a referenced currently offered examination; the Board may accept equivalent prior qualifications and excuse a new sitting.
Fee
Pay the prescribed application fee unless a statutory waiver applies.
History disclosures
For affirmative professional or criminal history responses, submit an explanatory personal statement and all supporting documents.
Minimum age
At least 18 years old.
Moral character
Good moral character satisfactory to the Board.
National credential
Provide CRT or RRT evidence requested by the Board; any discontinued examination score is prior evidence.
Other licenses
Each relevant jurisdiction must send official verification of any professional license held now or previously directly to the Board.
Photo
Submit a 2x2 passport-style color photo with a white or off-white background.
Self query
Submit an unmodified National Practitioner Data Bank self-query.
Transcripts
Educational institutions must send complete official transcripts directly to the Board, identifying the degree and conferral date.
Initial licensure by examination
Application
Submit a complete, signed application with required supporting documentation.
Application fee
The currently posted ordinary-license application fee is $260; limited-license holders still pay the full fee.
Cori
Submit a signed and notarized CORI Acknowledgement Form.
Education
Complete a Board-approved respiratory therapy program and provide verification.
Fee
Pay the prescribed application fee unless a statutory waiver applies.
History disclosures
For affirmative professional or criminal history responses, submit an explanatory personal statement and all supporting documents.
Minimum age
At least 18 years old.
Moral character
Good moral character satisfactory to the Board.
National credential
Provide direct NBRC verification of either CRT or RRT certification. The alternative trees identify currently offered examinations underlying those accepted credentials; possession of an existing credential may satisfy the evidence requirement without a new sitting. Scores and credentials earned under discontinued predecessor examinations remain prior applicant evidence.
Other licenses
Each relevant jurisdiction must send official verification of any professional license held now or previously directly to the Board.
Passing score
Provide NBRC verification of a passing licensure examination score; CRT-level passage is sufficient, while the RRT alternative additionally involves CSE.
Photo
Submit a 2x2 passport-style color photo with a white or off-white background.
Self query
Submit an unmodified National Practitioner Data Bank self-query.
Supervised pending results
M.G.L. c.112, section 23T permits qualified examination applicants to practice under licensed supervision from filing until results; a failure terminates the privilege.
Transcripts
Educational institutions must send complete official transcripts directly to the Board, identifying the degree and conferral date.
Initial licensure with an expired out of jurisdiction RT license: The out of jurisdiction RT license has expired for at least two Massachusetts renewal periods (four years).
Therapist Multiple-Choice Examination
Application
Submit a complete, signed application with required supporting documentation.
Cori
Submit a signed and notarized CORI Acknowledgement Form.
Current exam name
Policy RC-09-03 uses the historical Entry Level CRT Examination name. The 2018 regulation still defines the licensure examination as CRT; the Board's 2025 minutes identify the current CRT examination as TMC. The discontinued separate CRT examination is not a leaf.
Current experience
The Board may require additional continuing education or retaking and passing the CRT licensure examination when evidence does not demonstrate relevant current respiratory-care experience. This discretion is a condition, not a universal retest requirement.
Expiration period
The out-of-jurisdiction RT license has expired for at least two Massachusetts renewal periods (four years).
Fee
Pay the prescribed application fee unless a statutory waiver applies.
History disclosures
For affirmative professional or criminal history responses, submit an explanatory personal statement and all supporting documents.
License verifications
Arrange direct verification from every jurisdiction in which any professional license has been held.
Minimum age
At least 18 years old.
Moral character
Good moral character satisfactory to the Board.
Other discipline
If the other license was disciplined, complete that licensing authority's reinstatement requirements and provide direct evidence of good standing or renewal eligibility; the Board may require supervised practice under a probation agreement.
Other licenses
Each relevant jurisdiction must send official verification of any professional license held now or previously directly to the Board.
Photo
Submit a 2x2 passport-style color photo with a white or off-white background.
Self query
Submit an unmodified National Practitioner Data Bank self-query.
Transcripts
Educational institutions must send complete official transcripts directly to the Board, identifying the degree and conferral date.
Work history
Provide a resume documenting work history since expiration, employers, dates, positions, duties, educational programs, and earned degrees.
Initial licensure with an expired out of jurisdiction RT license: The out of jurisdiction RT license has expired for more than 90 days but less than four years.
Therapist Multiple-Choice Examination
Application
Submit a complete, signed application with required supporting documentation.
Cori
Submit a signed and notarized CORI Acknowledgement Form.
Current exam name
Policy RC-09-03 uses the historical Entry Level CRT Examination name. The 2018 regulation still defines the licensure examination as CRT; the Board's 2025 minutes identify the current CRT examination as TMC. The discontinued separate CRT examination is not a leaf.
Current experience
The Board may require additional continuing education or retaking and passing the CRT licensure examination when evidence does not demonstrate relevant current respiratory-care experience. This discretion is a condition, not a universal retest requirement.
Expiration period
The out-of-jurisdiction RT license has expired for more than 90 days but less than four years.
Fee
Pay the prescribed application fee unless a statutory waiver applies.
History disclosures
For affirmative professional or criminal history responses, submit an explanatory personal statement and all supporting documents.
License verifications
Arrange direct verification from every jurisdiction in which any professional license has been held.
Minimum age
At least 18 years old.
Moral character
Good moral character satisfactory to the Board.
Other discipline
If the other license was disciplined, complete that licensing authority's reinstatement requirements and provide direct evidence of good standing or renewal eligibility; the Board may require supervised practice under a probation agreement.
Other licenses
Each relevant jurisdiction must send official verification of any professional license held now or previously directly to the Board.
Photo
Submit a 2x2 passport-style color photo with a white or off-white background.
Self query
Submit an unmodified National Practitioner Data Bank self-query.
Transcripts
Educational institutions must send complete official transcripts directly to the Board, identifying the degree and conferral date.
Work history
Provide a resume documenting work history since expiration, employers, dates, positions, duties, educational programs, and earned degrees.
Initial licensure with an expired out of jurisdiction RT license: The out of jurisdiction RT license has expired for 90 days or less.
Therapist Multiple-Choice Examination
Application
Submit a complete, signed application with required supporting documentation.
Cori
Submit a signed and notarized CORI Acknowledgement Form.
Current exam name
Policy RC-09-03 uses the historical Entry Level CRT Examination name. The 2018 regulation still defines the licensure examination as CRT; the Board's 2025 minutes identify the current CRT examination as TMC. The discontinued separate CRT examination is not a leaf.
Current experience
The Board may require additional continuing education or retaking and passing the CRT licensure examination when evidence does not demonstrate relevant current respiratory-care experience. This discretion is a condition, not a universal retest requirement.
Expiration period
The out-of-jurisdiction RT license has expired for 90 days or less.
Fee
Pay the prescribed application fee unless a statutory waiver applies.
History disclosures
For affirmative professional or criminal history responses, submit an explanatory personal statement and all supporting documents.
License verifications
Arrange direct verification from every jurisdiction in which any professional license has been held.
Minimum age
At least 18 years old.
Moral character
Good moral character satisfactory to the Board.
Other discipline
If the other license was disciplined, complete that licensing authority's reinstatement requirements and provide direct evidence of good standing or renewal eligibility; the Board may require supervised practice under a probation agreement.
Other licenses
Each relevant jurisdiction must send official verification of any professional license held now or previously directly to the Board.
Photo
Submit a 2x2 passport-style color photo with a white or off-white background.
Self query
Submit an unmodified National Practitioner Data Bank self-query.
Transcripts
Educational institutions must send complete official transcripts directly to the Board, identifying the degree and conferral date.
Initial licensure by reciprocity
No examination is required for this applicant pathway.
Application
Submit a complete, signed application with required supporting documentation.
Board application demand
The general Board application page states: "National Board of Respiratory Care (NBRC) documentation of certification. You must have obtained a passing score on NBRC’s CCRT examination. NBRC must send the documentation directly to the Board.". The specific reciprocity rule lists prior licensure, substantial equivalence, and good standing without imposing an examination; that higher-ranked rule controls this pathway, while the applicant should address the Board page's demand with the Board.
Cori
Submit a signed and notarized CORI Acknowledgement Form.
Equivalence
Provide any evidence requested showing substantially equivalent licensing requirements.
Fee
Pay the prescribed application fee unless a statutory waiver applies.
Good standing
Provide evidence satisfactory to the Board that the other license is in good standing.
History disclosures
For affirmative professional or criminal history responses, submit an explanatory personal statement and all supporting documents.
Minimum age
At least 18 years old.
Moral character
Good moral character satisfactory to the Board.
Other licenses
Each relevant jurisdiction must send official verification of any professional license held now or previously directly to the Board.
Photo
Submit a 2x2 passport-style color photo with a white or off-white background.
Prior license
Hold a license in another United States jurisdiction specified in 261 CMR 3.06(2).
Self query
Submit an unmodified National Practitioner Data Bank self-query.
Transcripts
Educational institutions must send complete official transcripts directly to the Board, identifying the degree and conferral date.

Official no-examination sources

Effective from 2026-09-22.

  • statute-23U.html

    M.G.L. c.112, §23U, licensure without examination

  • rule3.pdf

    261 CMR 3.06(2)(a)-(b), eligibility for reciprocity

  • rule3.pdf

    261 CMR 3.06(2)(c), reciprocity submission requirements

  • apply.html

    What you need, NBRC documentation

  • apply.html

    What you need, self-query, CORI, other licenses and disclosures

Expedited initial licensure for an accompanying military spouse
No examination is required for this applicant pathway.
Application
Submit a complete, signed application with required supporting documentation.
Board application demand
The general Board application page states: "National Board of Respiratory Care (NBRC) documentation of certification. You must have obtained a passing score on NBRC’s CCRT examination. NBRC must send the documentation directly to the Board.". The specific reciprocity rule lists prior licensure, substantial equivalence, and good standing without imposing an examination; that higher-ranked rule controls this pathway, while the applicant should address the Board page's demand with the Board.
Cori
Submit a signed and notarized CORI Acknowledgement Form.
Documentation
Upload spouse transfer orders naming the applicant as a dependent and/or a marriage certificate; attest in the application.
Equivalence
Provide substantial-equivalence and good-standing evidence as required by 261 CMR 3.06(2).
Fee
Pay the prescribed application fee unless a statutory waiver applies.
History disclosures
For affirmative professional or criminal history responses, submit an explanatory personal statement and all supporting documents.
Initial fee waiver
Commonwealth initial application and license fees are waived under section 1B(g).
Military transfer
Spouse is an armed-forces member transferred to Massachusetts; the applicant left employment to accompany that spouse.
Minimum age
At least 18 years old.
Moral character
Good moral character satisfactory to the Board.
Other licenses
Each relevant jurisdiction must send official verification of any professional license held now or previously directly to the Board.
Photo
Submit a 2x2 passport-style color photo with a white or off-white background.
Prior license
Already licensed or certified outside Massachusetts.
Review
Section 1B(d) requires action within 30 days, which may be a full license, temporary license, or notice of unmet requirements or missing information.
Self query
Submit an unmodified National Practitioner Data Bank self-query.
Transcripts
Educational institutions must send complete official transcripts directly to the Board, identifying the degree and conferral date.

Official no-examination sources

Effective from 2026-09-22.

  • statute-1B.html

    M.G.L. c.112, §1B(d), expedited and temporary military spouse licensure

  • statute-1B.html

    M.G.L. c.112, §1B(g), public health initial fees waived

  • military.html

    About the VALOR Act, military training, renewal, and spouses

  • valor-current.html

    How to file, current documentation since June 23, 2025

  • statute-23U.html

    M.G.L. c.112, §23U, licensure without examination

  • rule3.pdf

    261 CMR 3.06(2)(a)-(b), eligibility for reciprocity

  • rule3.pdf

    261 CMR 3.06(2)(c), reciprocity submission requirements

  • apply.html

    What you need, NBRC documentation

Initial examination licensure with military education, training, or service credit
Application
Submit a complete, signed application with required supporting documentation.
Application fee
The currently posted ordinary-license application fee is $260; limited-license holders still pay the full fee.
Cori
Submit a signed and notarized CORI Acknowledgement Form.
Education
Complete a Board-approved respiratory therapy program and provide verification.
Fee
Pay the prescribed application fee unless a statutory waiver applies.
History disclosures
For affirmative professional or criminal history responses, submit an explanatory personal statement and all supporting documents.
Initial fee waiver
The Commonwealth initial application and license fees are waived when the application is granted under section 1B.
Military credit
Present satisfactory evidence of relevant armed-forces or military-reserve education, training, or service for acceptance toward licensing qualifications.
Military documentation
Submit DD214 or other proof of military service, or current active-duty orders, and attest in the application under the current VALOR procedure.
Minimum age
At least 18 years old.
Moral character
Good moral character satisfactory to the Board.
National credential
Provide direct NBRC verification of either CRT or RRT certification. The alternative trees identify currently offered examinations underlying those accepted credentials; possession of an existing credential may satisfy the evidence requirement without a new sitting. Scores and credentials earned under discontinued predecessor examinations remain prior applicant evidence.
Other licenses
Each relevant jurisdiction must send official verification of any professional license held now or previously directly to the Board.
Passing score
Provide NBRC verification of a passing licensure examination score; CRT-level passage is sufficient, while the RRT alternative additionally involves CSE.
Photo
Submit a 2x2 passport-style color photo with a white or off-white background.
Self query
Submit an unmodified National Practitioner Data Bank self-query.
Supervised pending results
M.G.L. c.112, section 23T permits qualified examination applicants to practice under licensed supervision from filing until results; a failure terminates the privilege.
Transcripts
Educational institutions must send complete official transcripts directly to the Board, identifying the degree and conferral date.
Reactivation or late renewal of an expired license: Renewal requested after more than two succeeding licensure periods.
No examination is required for this applicant pathway.
Application and fee
Submit the renewal application and prescribed fee.
Ce period
Document CE required for the current renewal period; the posted policy also calls for an application fee and case-by-case review.
Continuing education
Complete 20 contact hours of qualifying continuing education per two-year renewal period using activities that do not require a registered licensure examination; keep records for the two prior periods. Courses' embedded progress or completion tests are educational conditions, not separate registered examinations.
Cycle
Renew every even-numbered year by May 31.
Documents
Contact the Board with name, address and phone number; submit CE documentation, work-history resume, other license verifications, renewal form, questionnaire, renewal and late fees, and any additional documentation requested.
Excluded credits
No carryover between cycles; Board-ordered or consent-agreement CE does not count toward ordinary renewal.
Existing license
Hold an ordinary Massachusetts respiratory therapist license.
Expiration period
Renewal requested after more than two succeeding licensure periods.
Late renewal discretion
Section 23S(2) permits an examination, CE, or supervised experience for late renewal but identifies no particular examination. The current expired-license submission procedure names no examination; any unspecified additional assessment the Board orders is an applicant condition.
No practice
No respiratory care practice or use of the professional title while the license is expired.
Staff policy status
The Board currently posts Licensing Policy 2015-01 with a PROPOSED AMENDMENTS heading and an adopted/amended date. Its distinctions are recorded as posted administrative conditions; the current Board reinstatement page independently establishes the no-named-examination submission pathway.

Official no-examination sources

Effective from 2026-09-22.

Reactivation or late renewal of an expired license: Renewal requested within two succeeding licensure periods.
No examination is required for this applicant pathway.
Application and fee
Submit the renewal application and prescribed fee.
Ce period
Document all required CE since the license was last issued or renewed.
Continuing education
Complete 20 contact hours of qualifying continuing education per two-year renewal period using activities that do not require a registered licensure examination; keep records for the two prior periods. Courses' embedded progress or completion tests are educational conditions, not separate registered examinations.
Cycle
Renew every even-numbered year by May 31.
Documents
Contact the Board with name, address and phone number; submit CE documentation, work-history resume, other license verifications, renewal form, questionnaire, renewal and late fees, and any additional documentation requested.
Excluded credits
No carryover between cycles; Board-ordered or consent-agreement CE does not count toward ordinary renewal.
Existing license
Hold an ordinary Massachusetts respiratory therapist license.
Expiration period
Renewal requested within two succeeding licensure periods.
Late renewal discretion
Section 23S(2) permits an examination, CE, or supervised experience for late renewal but identifies no particular examination. The current expired-license submission procedure names no examination; any unspecified additional assessment the Board orders is an applicant condition.
No practice
No respiratory care practice or use of the professional title while the license is expired.
Staff policy status
The Board currently posts Licensing Policy 2015-01 with a PROPOSED AMENDMENTS heading and an adopted/amended date. Its distinctions are recorded as posted administrative conditions; the current Board reinstatement page independently establishes the no-named-examination submission pathway.

Official no-examination sources

Effective from 2026-09-22.

Automatic renewal and continued validity during active military service
No examination is required for this applicant pathway.
Active service
The licensee is engaged in active United States armed-forces service.
Documentation
Provide current active-duty orders and attest in the application where required.
Validity
License remains valid until release and for at least 90 days after release under section 1B(c).
Waivers
The current BHPL implementation automatically renews active-duty service members' licenses without a renewal fee or CE completion.

Official no-examination sources

Effective from 2026-09-22.

Renewal through qualifying continuing education without a credentialing examination
No examination is required for this applicant pathway.
Application and fee
Submit the renewal application and prescribed fee.
Continuing education
Complete 20 contact hours of qualifying continuing education per two-year renewal period using activities that do not require a registered licensure examination; keep records for the two prior periods. Courses' embedded progress or completion tests are educational conditions, not separate registered examinations.
Cycle
Renew every even-numbered year by May 31.
Excluded credits
No carryover between cycles; Board-ordered or consent-agreement CE does not count toward ordinary renewal.
Existing license
Hold an ordinary Massachusetts respiratory therapist license.

Official no-examination sources

Effective from 2026-09-22.

  • statute-23S.html

    M.G.L. c.112, §23S(2), renewal and late renewal

  • rule3.pdf

    261 CMR 3.08, renewal requirements and nonrenewability of limited licenses

  • rule5.pdf

    261 CMR 5.02(1)-(2)(a), standard hours and first-cycle exemption

First renewal cycle after initial licensure by examination
No examination is required for this applicant pathway.
Application and fee
Submit a renewal application and prescribed fee; renewal occurs in even-numbered years.
Continuing education exemption
Exempt from the standard CE requirement during the first renewal cycle under 261 CMR 5.02(2)(a).
Initial pathway
The license was obtained by examination.

Official no-examination sources

Effective from 2026-09-22.

  • statute-23S.html

    M.G.L. c.112, §23S(2), renewal and late renewal

  • rule3.pdf

    261 CMR 3.08, renewal requirements and nonrenewability of limited licenses

  • rule5.pdf

    261 CMR 5.02(1)-(2)(a), standard hours and first-cycle exemption

Renewal electing NBRC recredentialing examination credit
Application and fee
Submit the renewal application and prescribed fee.
Continuing education
Complete 20 contact hours of qualifying continuing education per two-year renewal period using activities that do not require a registered licensure examination; keep records for the two prior periods. Courses' embedded progress or completion tests are educational conditions, not separate registered examinations.
Credential restriction
RRT holders may not apply CRT recredentialing examination credit. A TMC sitting relied on as the former written registry must meet the appropriate NBRC credential standard, and the applicant must satisfy the selected examination's eligibility requirements.
Credit cap
At most four contact hours per renewal period may come from recredentialing examinations; complete the remaining required hours separately.
Cycle
Renew every even-numbered year by May 31.
Examination credits
Elect NBRC recredentialing examination credits toward renewal: the NBRC examination formerly called written registry earns two hours, clinical simulation earns four hours, and the perinatal/pediatric specialty examination earns two hours. They are alternatives, not a mandatory combination.
Excluded credits
No carryover between cycles; Board-ordered or consent-agreement CE does not count toward ordinary renewal.
Existing license
Hold an ordinary Massachusetts respiratory therapist license.
Predecessors
The separate Written Registry and CRT examinations replaced in January 2015 are omitted; the TMC reference is grounded in the Board's current NBRC/CRT descriptions, and CSE remains the separately identified clinical simulation examination.
Unregistered national exam
The Board accepts the Perinatal/Pediatric Specialty examination, currently named the Neonatal/Pediatric Respiratory Care Specialty (NPS) Examination by NBRC. It is currently offered but no frozen exam version for it was supplied; until nationwide registration it is a condition, not a leaf.
Restoration of the ordinary license after rescission of summary suspension
No examination is required for this applicant pathway.
Board final decision
The Board concludes that practice does not present an immediate and serious threat or that summary suspension is unnecessary to prevent the threat.
Original limits
The restored license retains any applicable original limited-license restrictions or expiration.
Restored status
The Board rescinds the summary suspension and restores exactly the preceding license status; no examination is prescribed by 261 CMR 4.05(5)(c).

Official no-examination sources

Effective from 2026-09-22.

  • rule4.pdf

    261 CMR 4.05(5)(c), rescission and restoration

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

Clinical Simulation 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 clinical simulation examination of patient-management problems with information-gathering and decision-making sections; each section of each problem is classified to a minor content heading of the Detailed Content Outline. Admission requires the CRT and a TMC pass at the high cut score; with the implementation of the Respiratory Therapy Examination the CSE is available only to those who passed the TMC at the high cut score by December 31, 2026, and it ends December 31, 2027
Exam questions
22 problems: 20 scored and 2 pretest
Time limit
4 hours
Passing score
Points associated with the candidate’s set of responses are summed across the whole examination into one score compared with a cut score linked to examination committee decisions on whether each positively-scored option is required as a demonstration of minimal competence
Exam fee
$200 for both new and repeat applicants
Examination outline
  • I. PATIENT DATA
    • I.A. Evaluate Data in the Patient Record — 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 — 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 — 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 exercise 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 — 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 exercise 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 — 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 EQUIPMENT, AND INFECTION CONTROL
    • II.A. Assemble /Troubleshoot Devices — 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 — 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 — 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
    • III.A. Maintain a Patent Airway Including the Care of Artificial Airways — 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 — 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 device; 4. Assisted cough, for example, huff, abdominal thrust; 5. Hyperinflation therapy; 6. Inspiratory muscle training
    • III.C. Support Oxygenation and Ventilation — 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 — 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 — 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 — 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 Techniques in High-Risk Situations — 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 — 1. Intubation; 2. Bronchoscopy; 3. Specialized bronchoscopy, for example, 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 — 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