Follow the steps to successfully fill out the form online.

1. Click ‘Get Form’ button to access the form and open it for completion.
2. Begin by entering the full name of the certified nurse aide (CNA) at the designated field.
3. Input the CNA’s street address, ensuring to include the city, state, and ZIP code.
4. Provide the CNA’s telephone number and Social Security number, which is required for processing.
5. Indicate the date of birth and the CNA registration number in the appropriate fields.
6. Fill in the date of hire and the date of termination if applicable.
7. Enter the job title and CNA expiration date.
8. In the CNA job function section, specify the number of hours worked performing nursing or nursing-related services within the last twenty-four consecutive months.
9. For in-services, confirm whether the CNA has received twelve or more in-service education and training hours each year, checking the relevant topics.
10. In the agency identification section, input the director’s or RN’s name, the name and address of the health care facility, and the facility number.
11. Finally, have the director or RN sign to attest to the accuracy of the information provided.
12. Review all entries for completeness, save changes, download, print, or share the filled-out form as needed.

Complete the IN IDOH State Form 49937 online to ensure a smooth renewal process.