Indiana Qualified Medication Aide Record of Annual In-Service Training

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.

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.

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

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.