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Fill in Your Indiana Department Annual Inservice Form

The Indiana Department Annual Inservice form is a required document for Qualified Medication Aides (QMAs) to report their annual in-service training. This form ensures that QMAs meet the necessary education requirements related to medication administration. Completing this form accurately and submitting it on time is crucial for maintaining certification.

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Fill in Your Indiana Department Annual Inservice Form

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Similar forms

The Qualified Medication Aide (QMA) Record of Annual In-Service Training is similar to the Certified Nursing Assistant (CNA) Renewal Application. Both documents require individuals to demonstrate ongoing education and training to maintain their certification. The CNA Renewal Application mandates that CNAs complete a specific number of continuing education hours and submit proof of this training along with a fee. Just like the QMA form, it emphasizes the importance of timely submission to avoid penalties or lapses in certification.

Another document that shares similarities is the Licensed Practical Nurse (LPN) License Renewal Application. This form also requires evidence of continuing education as part of the renewal process. LPNs must provide documentation of completed courses or training hours, similar to the QMA's requirement for annual in-service education. Both forms are essential for maintaining licensure and ensuring that practitioners stay updated on best practices in their fields.

If you're looking to transfer ownership of a boat, consider utilizing a comprehensive Boat Bill of Sale documentation. You can prepare this important paper by visiting the Boat Bill of Sale template page to access and fill out the necessary form for your transaction.

The Registered Nurse (RN) License Renewal Application is comparable as well. RNs are required to complete continuing education credits to qualify for license renewal. The RN application, like the QMA form, includes sections for detailing the education completed and ensuring that the necessary fees are paid. Both documents highlight the commitment to professional development and patient safety through education.

The Medication Administration Record (MAR) serves a different function but is related in its focus on medication management. While the QMA form tracks in-service training, the MAR documents the administration of medications to patients. Both are crucial in ensuring that medication is handled safely and effectively, emphasizing the importance of accurate record-keeping in healthcare settings.

The Continuing Education Unit (CEU) Certificate is another document that aligns with the QMA in-service form. CEUs are often required for various healthcare certifications and serve as proof that a professional has completed specific educational programs. Just like the QMA form, CEU certificates must be submitted to relevant authorities to maintain licensure and demonstrate ongoing education.

The State Health Department's Annual Report for Healthcare Facilities is similar in that it requires facilities to report on training and education provided to staff. This document ensures that facilities comply with state regulations regarding staff qualifications and ongoing education, mirroring the QMA's requirement for individual training documentation.

The Clinical Competency Evaluation form is another related document. This form assesses healthcare professionals' skills and knowledge, similar to how the QMA form tracks in-service education. Both documents serve to ensure that caregivers are competent and up-to-date in their practices, ultimately benefiting patient care.

Finally, the Emergency Medical Technician (EMT) Continuing Education Record shares similarities with the QMA form. EMTs must also complete a certain number of continuing education hours to maintain their certification. Both forms require detailed documentation of training completed and emphasize the importance of staying informed about current practices in emergency care.

FAQ

What is the purpose of the Indiana Department Annual Inservice form?

The Indiana Department Annual Inservice form is designed for Qualified Medication Aides (QMAs) to document their completion of required in-service education related to medication administration. This form ensures that QMAs meet the annual training requirements necessary for certification and re-certification, as mandated by the Indiana State Department of Health.

What are the key requirements for completing the Annual Inservice form?

To complete the Annual Inservice form, QMAs must provide accurate information including their name, certification number, home address, and contact information. They must also list the topics of their in-service education, the locations where the training occurred, and the duration of each session. Additionally, they must sign the form to certify that they have met the six-hour annual in-service education requirement.

When is the deadline for submitting the Annual Inservice form?

The completed Annual Inservice form and the appropriate fee must be submitted to the Indiana State Department of Health by March 31 each year. It is crucial to meet this deadline to avoid potential penalties or removal from the QMA registry.

How many hours of in-service education are required each year?

Each year, QMAs are required to complete a minimum of six hours of in-service education specifically related to medication administration. This requirement helps ensure that QMAs remain knowledgeable about best practices and any changes in medication protocols.

What happens if I miss the deadline for submitting my form?

If the form and fee are submitted more than 91 days after the expiration of your certification, you will be removed from the QMA registry. To regain your status, you must complete an approved QMA course, submit an application to the testing entity, and pass the competency test.

Can I submit the Annual Inservice form online?

Currently, the Indiana State Department of Health requires the form and fee to be submitted by mail. Ensure that you send your completed form along with a check or money order for the fee to the designated address provided in the instructions.

What topics should the in-service education cover?

The in-service education must relate to medication administration. If applicable, it should also cover specialized topics such as G-tube/J-tube medication administration, hemoccult testing, and finger stick blood glucose testing. This ensures that QMAs are equipped to handle various medication administration scenarios effectively.

Who is responsible for maintaining documentation of in-service education?

The responsibility for maintaining documentation of in-service education lies with the QMA. They must keep accurate records of their training and ensure that the Annual Inservice form is completed and submitted correctly to the Indiana State Department of Health.

What is the fee associated with submitting the Annual Inservice form?

The fee for submitting the Annual Inservice form is $10. This can be paid via check or money order made out to the Indiana State Department of Health. Ensure that the payment is included with your form to avoid delays in processing your certification.

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Common mistakes

Completing the Indiana Department Annual Inservice form requires careful attention to detail. One common mistake is failing to print or type clearly. Legibility is crucial; if the information cannot be read, it may delay processing or lead to errors. Always take the time to ensure that all entries are clear and easy to understand.

Another frequent error involves the use of abbreviations. The instructions explicitly state that no abbreviations should be used. Using shorthand can lead to confusion and misinterpretation of the information provided. It’s essential to write out all terms fully to avoid any potential issues.

Many individuals overlook the deadline for submission. The form and fee must be submitted to the Indiana State Department of Health by March 31. Missing this deadline can result in late fees or even removal from the QMA registry. Staying organized and setting reminders can help ensure timely submission.

Inaccurate documentation of in-service education hours is another mistake. The form requires that a minimum of six hours of annual in-service education related to medication administration be documented. Failing to meet this requirement can jeopardize certification. Always double-check that the hours recorded are accurate and relevant.

Another area of concern is the omission of mandatory information. Items such as the QMA name, certification number, and signature of the instructor are crucial. If any of these fields are left blank, the form will be returned, causing delays. Review the form carefully before submission to ensure all required fields are completed.

Additionally, some individuals may forget to include the appropriate fee. The submission must include a check or money order for $10, made out to the Indiana State Department of Health. Failing to include payment will result in the form being returned. It’s advisable to verify that payment is included before sending the form.

Lastly, neglecting to maintain documentation of in-service education can lead to complications. The QMA is responsible for keeping records of all in-service education completed. If questioned, having this documentation readily available is essential for verification. Keeping organized records can prevent future issues with certification.

Indiana Department Annual Inservice Preview

QUALIFIED MEDICATION AIDE RECORD OF ANNUAL IN-SERVICE TRAINING

State Form 51654 (R / 11-09)

Approved by State Board of Accounts, 2009

INDIANA STATE DEPARTMENT OF HEALTH - DIVISION OF LONG TERM CARE

INSTRUCTIONS: 1. Please print or type clearly.

2.No abbreviations.

3.This form and fee must be submitted to ISDH by March 31.

4.The QMA is responsible for completing the in-service education requirements, maintaining documentation of in- service education, and submitting, or ensuring the submission of, the qualified medication aide record of annual in- service education form and appropriate fee. Annual in-service education MUST relate to medication and/or medication administration. If a QMA performs medication administration via a G-tube/J-tube, hemoccult testing, finger stick blood glucose testing, annual in-service must be done yearly.

QMA Name: _______________________________________QMA Certification #:______________________

LastFirstM.I

Home Address: ___________________________________________________________________________

(street address (include Post Office box number, if applicable) City State ZIP code

Phone: __ ___/_________________ CNA Expiration Date*: __________________(CNA status MUST be current)

Payment (check one)*: _____Fee included OR _______Date paid online

Date

Topic

Location (facility name)

Length

(in ¼ hour

segments, i.e., 0.25, 0.50, 0.75, 1.0 hour)

Signature of Instructor*

	Approved		Not
			Approved

Office Use Only
















Office Use Only TOTAL APPROVED HOURS:	REVIEWED BY:	Date:

I submit the above information as proof of having met the six (6) hour per year in-service requirement and hereby apply for re-certification.

QMA Signature*: ___________________________________________

Date:___________________

*Mandatory information, form will be returned if * items are not completed.

For office use only:

Entered by:_______________________________

Date:_______________-____________________

Receipt #

IMPORTANT NOTICE

CERTIFICATION/RECERTIFICATION/REINSTATEMENT and IN-SERVICE EDUCATION REQUIREMENTS FOR

QUALIFIED MEDICATION AIDE (QMA)

Effective January 1, 2005, the QMA certification process and in-service education requirement is mandatory every year. This is in accordance with Indiana Administrative Code 412 IAC 2-1-10. Under this rule all QMAs must meet the following three (3) requirements:

1.Be certified by the Indiana State Department of Health every year;

2.Obtain a minimum of six (6) hours per year of in-service education in the area of medication administration; and

3.Submit appropriate fee to Indiana State Department of Health with recertification request.

RECERTIFICATION:

At least 30 days prior to the expiration of the certificate, the individual must:

1.obtain a minimum of six (6) hours per year of annual in-service education;

2.submit to the Indiana State Department of Health a qualified medication aide record of annual in-service education on the form approved by the ISDH; and

3.submit to the ISDH the appropriate fee.

The QMA is responsible for completing the in-service education requirements, maintaining documentation of in-service education, and submitting, or ensuring the submission of, the qualified medication aide record of annual in-service education form and appropriate fee.

REINSTATEMENT:

If the recertification fees and/or in-service education form is received by the ISDH ninety-one (91) or more days after expiration of the QMA certification, the individual is removed from the QMA registry and must be reinstated. For reinstatement as a QMA following removal from the QMA registry, the individual must:

1.complete an ISDH approved QMA course;

2.submit to the testing entity an application approved by the ISDH;

3.pass the written competency test in three (3) or fewer attempts with a passing score of 80%.

IN-SERVICE EDUCATION REQUIREMENTS:

Annual in-service education shall include medication administration. If facility policy allows the QMA to perform such functions in the facility, annual in-service education shall also include:

1.medication administration via G-tube/J-tube;

2.hemoccult testing;

3.finger stick blood glucose testing (specific to the glucose meter used).

QMA certificates are effective upon issue and expire on March 31 of the next year. The annual in-service education requirement period begins each year on March 1 and concludes on the last day of February of the next year. In the case of an initial certificate, the annual in-service education requirement period begins on the QMA certification effective date and concludes on the last day of February of the next year. The in-service education requirement period therefore ends one (1) month prior to the expiration of the certification.

Qualified Medication Aide Record of Annual In-service Training form and fee ($10.00 check or money order payable to Indiana State Dept. of Health) should be submitted to ISDH. The form and fee must be sent to:

Indiana State Department of Health

Cashier’s Office

PO Box 7236

Indianapolis, IN 46207-7236

Failure to submit certification in a timely manner may result in additional fees or removal from the QMA registry. (Removal from the registry will require completion of a QMA course and passing of the QMA competency test for re- instatement).

If you have additional questions, please contact Gina Berkshire at gberkshire@isdh.in.gov or 317/233-7497

or Nancy Gilbert at ngilbert@isdh.in.gov or 317/233-7616.

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