Get In 51654 2021-2025

Filling out the IN 51654 form is an essential process for qualified medication aides (QMAs) to document their annual inservice training. This guide will provide clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the IN 51654 form online

1. Click the ‘Get Form’ button to obtain the form and open it in the designated online editor.
2. Enter your name in the designated fields, including your last name, first name, and middle initial.
3. Provide your QMA certification number to verify your qualifications.
4. Fill in your address, making sure to include the house or apartment number and street name.
5. Add your city, state, and ZIP code in the respective fields.
6. Include a valid telephone number, including the area code, for contact purposes.
7. Input the date of training completion in the format of mm/dd/yy.
8. Ensure to provide your email address for electronic communication.
9. In the topic section, specify the subjects of inservice training, focusing only on medication, medication administration, and QMA scope of practice.
10. The instructor must sign the form, providing their credentials to validate the training.
11. Record the length of training in quarter-hour increments, as applicable.
12. Leave the IDOH use only section blank; it is reserved for state use only.
13. Calculate the total hours of training completed and fill in that amount in the designated field.
14. Finally, the QMA must sign and date the form, indicating confirmation of the hours reported.

Complete your IN 51654 form online today and ensure your training records are up-to-date.