Get La Designated Signatures Form 2022-2025

Filling out the LA Designated Signatures Form online is essential for healthcare facilities to maintain proper documentation of approved signatories for the submission of the NAT-7 Form. This guide provides a clear and user-friendly overview of how to effectively complete each section of the form.

Follow the steps to complete the LA Designated Signatures Form

1. Press the ‘Get Form’ button to access the document and open it for editing.
2. In the first section, input the date on which you are completing the form. This helps establish a timeline for your submissions.
3. Enter the facility or program name accurately to identify your organization.
4. Fill in the mailing address, including the city, state, zip code, phone, and fax numbers for your facility. This information is crucial for communication.
5. Provide the facility code, which allows your healthcare facility to report the employment history of CNAs to the LA Nurse Aide Registry.
6. List your email address and the state ID to ensure all contact information is current and allows for effective correspondence.
7. Designate at least two authorized individuals by printing their names and obtaining their handwritten signatures. You can include up to four individuals, ensuring that you comply with the requirements outlined.
8. Remember that you need to include all individuals who should remain as designated signers, as any previous authorizations will be removed upon submission of this form.
9. Once all fields are completed accurately, you can choose to save the changes, and then download or print the form for submission.
10. Submit the form to the LA Nurse Aide Registry via the provided email address or mailing address. Make sure submissions originate from your facility’s email account.

Complete your documents online today for a seamless submission process.