Get In 51654 2018

The IN 51654 form, also known as the Qualified Medication Aide Record of Annual Inservice Training, is essential for documenting inservice training hours. This guide will provide step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the IN 51654 form online

1. Click ‘Get Form’ button to obtain the form and open it for filling.
2. Begin by filling in your name in the 'Name' field using your last name, first name, and middle initial for clear identification.
3. Enter your QMA certification number in the designated field to verify your certification status.
4. Complete the address section with your number and street name, followed by your telephone number including the area code.
5. Fill in your city, state, and ZIP code in the appropriate fields.
6. Provide the date of the training session in the format (mm/dd/yy).
7. Document the topic of the training in the 'Topic' field, ensuring it relates to medication, medication administration, or QMA Scope of Practice only.
8. Have the instructor sign and include their credentials in the corresponding area.
9. Indicate the length of the training in quarter-hour increments in the designated field.
10. Proceed to fill in the 'ISDH Use Only' section as required.
11. Finally, calculate and enter the total hours of training completed.
12. Sign and date the form in the QMA signature section, ensuring the date is recorded in (mm/dd/yy) format.
13. Once all fields are completed, save your changes, download the document, print it, or share it as needed.

Complete your IN 51654 form online today to ensure your compliance with annual inservice training requirements.