Get Az Certified Medication Assistant (cma) Request For Waiver 2017-2026

This guide provides a comprehensive overview of how to complete the AZ Certified Medication Assistant (CMA) Request For Waiver form online. By following these clear steps, users can efficiently fill out the required information and ensure their application is accurately submitted.

Follow the steps to successfully complete your waiver request.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Enter your personal information in the applicant information section. This includes your name, social security number, address, city, state, zip code, telephone number, and email address.
3. Read the certification statement carefully. Once you understand the qualifications and responsibilities of a certified medication assistant as outlined in the Nurse Practice Act Statutes, confirm this by signing in the designated area for the applicant's signature and including the date.
4. For the waiver related to nursing students, provide information about your education. Fill in the name and address of the school, and ensure you have documentation verifying the nursing course completion, pharmacology course details, and clinical experience in a long-term care facility.
5. If applicable, to receive a waiver for certified medication assistants, include verification from an out-of-state registry that confirms you have completed 100 hours of training in a CMA program. Also, provide proof of at least 160 hours worked as a medication assistant if you have practiced in the past two years.
6. Fill in the course details for both the nursing fundamentals and pharmacology sections. Include the names of the courses and the total clock or credit hours for each.
7. Specify the dates of employment as a certified medication assistant, indicating both the start and end dates.
8. Ensure that you confirm whether you have spent 40 hours in clinical administering medications and if you have worked at least 160 hours as a CMA. Select 'Yes' or 'No' as appropriate.
9. Complete the verification signatures section by obtaining the signature of your instructor or program director, as well as your supervisor, to affirm the provided information is accurate.
10. Finally, provide the contact information for both the instructor and supervisor, including their phone numbers and email addresses. After reviewing all entries, you can save your changes, download the completed form, print it out, or share it as needed.

Begin your application today by completing the AZ Certified Medication Assistant (CMA) Request For Waiver online.