Get Request Form For Dhss Lima Certification - Missouri Assisted Living - Malarcf

This guide provides a comprehensive overview of how to complete the Request Form for DHSS LIMA Certification in Missouri. By following these steps, you will be able to successfully submit your application online and ensure you receive your certification smoothly.

Follow the steps to fill out the request form accurately.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online document editor.
2. Begin by filling in your legal name, including both your first and last names in the corresponding fields.
3. Provide your mailing address along with the city, state, and zip code to ensure accurate delivery of your certificate.
4. Enter your phone number to facilitate any necessary communication regarding your application.
5. Input your Social Security number in the required field for identification purposes.
6. Complete the date of birth field to establish your age eligibility for the certification.
7. Insert your DMH L1MA certificate number and the date it was issued, which can be found on your existing certification.
8. If the certificate needs to be mailed to a different address, fill in the facility name and address details as instructed.
9. Compile the necessary documents to enclose with your application, including photocopies of your driver’s license, Social Security card, and original DMH Level One Medication Aide certificate.
10. If relevant, obtain a verification letter from the Department of Mental Health for certifications over two years old and include that with your documentation.
11. Prepare your payment for the non-refundable fee, ensuring to select between the options for processing and method of payment.
12. Decide if you would like a copy emailed or faxed after processing and provide the appropriate contact information.
13. If using a debit or credit card for payment, fill in the card details and sign where required.
14. Review all the information entered in the form to ensure accuracy and completeness.
15. Once everything is completed, you can save your changes, download the form, print it, or share it as needed.

Begin your online application process today by completing the Request Form for DHSS LIMA Certification.