Get South Carolina Nursing Assistant Renewal Form 2020-2025

Filling out the South Carolina Nursing Assistant Renewal Form online is an essential process for maintaining your eligibility to work in federally certified facilities. This guide will provide you with clear, step-by-step instructions to help ensure that your form is completed correctly and efficiently.

Follow the steps to complete the Nursing Assistant Renewal Form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In Section I, enter your personal information: your Social Security number as it appears on the Nurse Aide Registry. If this number has changed, indicate 'new' alongside it.
3. Provide your full name in the 'Name on Certificate' field using your legal name (no nicknames).
4. Input your current mailing address, including street number and name, city, state, and ZIP code.
5. Fill in your current home and work telephone numbers.
6. Enter your certification number and the expiration date as shown on your Nurse Aide Certificate.
7. Sign and date the form in the Nurse Aide Signature field.
8. If there are changes to your personal information in Section II, add your new Social Security number and, if applicable, your current name. Attach supporting legal documentation to validate these changes.
9. In Section III, your current or most recent Nurse Aide employer must complete the relevant information about the health care facility, including its name, city, state, and phone number.
10. Your employer will also provide your date of hire and, if applicable, the date of termination.
11. Check ‘Yes’ or ‘No’ regarding whether you have worked for pay providing nursing-related duties for at least 8 hours during the past 24 months. If ‘Yes’, input the most recent date you worked.
12. The employer must sign and date in the Declaration & Signature section, verifying that the information provided is accurate.
13. In Section IV, note the renewal fee: if employed by a Medicaid-certified nursing home, confirm that your employer will cover the renewal fee. Otherwise, arrange for a money order for $28 made payable to Pearson VUE.
14. Mail the completed form, along with the renewal fee, to the specified address: Pearson VUE – SC Nurse Aide Registry, PO Box 822749, Philadelphia, PA 19182-2749. Allow for processing time and remember that incomplete or illegible forms cannot be processed.

Complete your South Carolina Nursing Assistant Renewal Form online today to ensure your continued eligibility in the registry.