Get In State Form 55844 2015-2025

This guide provides detailed instructions for completing the IN State Form 55844 online. It is essential for employers to accurately fill out this form to comply with the probationary requirements set by the Indiana State Board of Nursing.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the reporting period, including the start and end dates. Make sure to enter the dates in the required format (month, day, year).
3. Complete the employee details section by entering the name of the employee, their license number, the name of the employing facility, and the telephone number.
4. Provide the address for the employing facility, including the number and street, city, state, and ZIP code.
5. Fill in the name and title of the immediate supervisor, and indicate the date of initial employment as well as the position held by the employee.
6. In the attendance section, report the number of hours practiced, as well as any days absent or tardy since the last reporting period. Provide explanations where necessary.
7. Answer the questions regarding changes in position, performance deficiencies, and adherence to rules, policies, and procedures, and provide explanations as needed.
8. Evaluate the employee by marking the appropriate performance indicators (E, S, NI) for various factors such as attendance, communication skills, and overall performance.
9. Indicate if the employee administers medications and whether there are any restrictions. Also, note how often medication records are reviewed.
10. Answer questions regarding notification of the board order. Indicate if the nurse informed you, provided a copy, and returned a signed copy.
11. Ensure the signature of the supervising nurse is added along with their title and date signed.
12. Review the entire form for accuracy. Save changes, download, print, or share the form as necessary.

Complete the IN State Form 55844 online to ensure compliance with the Indiana State Board of Nursing.