Get In 51654 2013

The IN 51654 form, also known as the Qualified Medication Aide (QMA) Record of Annual In-Service Training, is essential for QMAs to document their annual training requirements. This guide provides clear, step-by-step instructions to assist you in completing the form online with ease.

Follow the steps to successfully complete the IN 51654 form.

1. Click the ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Begin by clearly printing or typing your name as a QMA, including your last name, first name, and middle initial.
3. Enter your QMA certification number in the specified field.
4. Provide your home address, including the street number, city, state, and ZIP code. Ensure all information is complete and accurate.
5. Input your telephone number, including the area code, ensuring that it is legible.
6. Select your payment option by checking the appropriate box provided for the fee included.
7. Enter the expiration date of your Certified Nursing Assistant (CNA) status. Make sure the date is current.
8. Record the date you paid online for the service.
9. Indicate which in-service training topics you completed by checking all that apply and providing the corresponding date and length of time for each entry. Length must be marked in quarter-hour segments only (e.g., .25, .50).
10. Ensure that the instructor's signature is original; this is a requirement for the form's validity.
11. Complete details about the facility where you work without using abbreviations.
12. Answer if the facility provided the in-service training, marking 'Yes' or 'No'. If not, include the name and location of the entity that provided the training.
13. Fill out the sections for additional medication-related in-services attended if applicable, following the same formatting as previous topics.
14. Sign and date the form, certifying that the information provided is accurate and proof of meeting the required in-service education.
15. After completing the form, save your changes, download it for your records, print it, or share it as necessary to ensure it reaches the appropriate authority.

Complete your documentation online now to ensure compliance with the QMA training requirements.