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The Indiana Department Annual Inservice form, officially known as the Qualified Medication Aide Record of Annual In-Service Training, represents a crucial tool in the professional life of a Qualified Medication Aide (QMA) within Indiana. Established by the Indiana State Department of Health's Division of Long Term Care and governed by stringent guidelines, this document plays a pivotal role in ensuring QMAs maintain the necessary six hours of annual in-service education specifically tailored to medication and/or its administration. Its significance extends to encompass not just the fulfillment of educational requirements but also acts as a gateway for certification renewal, directly impacting one's standing on the QMA registry. The structure of the form demands clear, unabbreviated input and includes mandatory fields that cover personal information, educational activities, payment details, and attestation of the completion of training hours. Submitted alongside a fee to the Indiana State Department of Health by March 31 each year, this form underscores the commitment to ongoing professional development and adherence to regulatory mandates, illustrating the comprehensive approach Indiana adopts towards ensuring healthcare providers are well-equipped to administer medications safely and effectively. Moreover, it highlights the procedural steps for certification renewal, reinstatement, and the potential consequences of failing to meet these annual requirements, showcasing the rigorous measures in place to uphold the highest standards of care within the long-term healthcare sector.

Example - Indiana Department Annual Inservice Form

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.

File Information

Fact Name Detail
Form Title Qualified Medication Aide Record of Annual In-Service Training
State Form Number 51654 (R / 11-09)
Approval Authority Approved by State Board of Accounts, 2009
Governing Law Indiana Administrative Code 412 IAC 2-1-10
Annual In-Service Education Hours Required Minimum of six (6) hours
Submission Deadline March 31
Fee Payment $10.00 check or money order payable to Indiana State Dept. of Health
Address for Submission Indiana State Department of Health Cashier’s Office PO Box 7236 Indianapolis, IN 46207-7236
Recertification Requirement Submit form, fee, and complete at least 6 hours of in-service education annually
Certificate Expiration Date March 31 of the next year
Reinstatement Conditions (After Removal) Complete an ISDH approved QMA course and pass the written competency test with a score of 80% in three (3) or fewer attempts

How to Fill Out Indiana Department Annual Inservice

For Qualified Medication Aides (QMA) in Indiana, meeting annual in-service training requirements is a vital step to ensure they are equipped with up-to-date practices in medication administration. This procedure emphasizes the importance of continuing education, as outlined by the Indiana State Department of Health (ISDH). Submitting the Indiana Department Annual In-service form before the March 31 deadline is part of this requirement and is necessary for the recertification of QMA status. The process involves documenting completed in-service education hours, which must be related to medication and/or its administration. With the guidance provided, QMAs can accurately fill out and submit their forms, ensuring they meet all necessary requirements to continue their practice.

  1. Start by printing or typing clearly on the form, ensuring all information is legible.
  2. It's important not to use abbreviations to avoid confusion. Spell out all terms fully.
  3. Fill in the QMA Name section with your last name, first name, and middle initial.
  4. Enter your QMA Certification Number in the designated area.
  5. Provide your complete home address, including street address or P.O. box number, city, state, and ZIP code.
  6. Include your phone number, making sure to separate the area code with spaces as indicated.
  7. Check your current CNA expiration date and fill it in, remembering your CNA status must be current.
  8. Indicate the payment method by checking the appropriate box for fee included or date paid online. Remember, the submission must include the required fee.
  9. Under the section for documenting your annual in-service education, list each date of training, the topic covered, and the location where it took place. Make sure to specify the length of each training session in quarter-hour segments.
  10. For each in-service training entry, obtain the signature of the instructor. This validates the accuracy of your reported hours and topics.
  11. Ensure that all entries for in-service training sum up to at least six hours, as this is the minimum requirement per year.
  12. After completing all sections, review your entries for accuracy and completeness. Incomplete forms or those missing mandatory information will be returned.
  13. Sign and date the form in the provided space to certify that the information submitted is correct and as proof of meeting the six-hour yearly in-service training requirement.
  14. Mail the completed form along with the required fee to the Indiana State Department of Health Cashier’s Office at the address provided. Make sure your submission is postmarked by March 31 to avoid late fees or penalties.

Upon submitting this form, the ISDH will review your in-service training records to verify that you meet the annual education requirements. Ensure all information is accurate and complete before submission to facilitate a smooth recertification process. Remember, staying current with these requirements not only aids in your recertification but also enhances your skills and knowledge as a Qualified Medication Aide.

Things to Know About Indiana Department Annual Inservice

What is the purpose of the Indiana Qualified Medication Aide Record of Annual In-Service Training form?

The purpose of the Indiana Qualified Medication Aide Record of Annual In-Service Training form is to provide evidence that a Qualified Medication Aide (QMA) has completed the necessary six hours of annual in-service education. This education is related to medication and/or medication administration and is a requirement for the QMA's recertification by the Indiana State Department of Health's Division of Long Term Care.

What are the deadlines for submitting the in-service education form and fee?

The form and the required fee must be submitted to the Indiana State Department of Health by March 31 each year. It's essential for the QMA to ensure these submissions are timely to avoid delays in recertification or any additional fees.

What happens if a QMA fails to submit the form or fee on time?

If a QMA fails to submit the form or fee on time, they may face additional fees or be removed from the QMA registry. In such cases, reinstatement would require completion of a QMA course and passing of the QMA competency test. It's critical to adhere to submission deadlines to maintain certification without interruption.

Are there specific topics that the annual in-service education must cover?

Yes, the annual in-service education must relate to medication administration and may include topics such as medication administration via G-tube/J-tube, hemoccult testing, and finger stick blood glucose testing. The focus of this training ensures that QMAs remain current with best practices and regulatory requirements related to their roles.

What is the fee for submitting the annual in-service education form?

The fee for submitting the annual in-service education form is $10.00, payable to the Indiana State Department of Health. This fee must accompany the form and can be paid by check or money order. Failure to include the fee with the form may result in processing delays or additional charges.

How can a QMA ensure they remain compliant with the in-service education requirements?

A QMA can ensure compliance with the in-service education requirements by obtaining a minimum of six hours of relevant education each year and submitting the completed Indiana Qualified Medication Aide Record of Annual In-Service Training form along with the appropriate fee by the March 31 deadline. It's also advisable for a QMA to maintain documentation of in-service education completed and to stay updated on any changes to requirements or processes by consulting the Indiana State Department of Health's Division of Long Term Care or visiting their website.

Common mistakes

When completing the Indiana Department Annual Inservice form, a few common mistakes can lead to delays or even prevent re-certification. Understanding these pitfalls can ensure that Qualified Medication Aides (QMAs) complete their forms correctly and fulfill their annual requirements without issue.

  1. Not printing or typing clearly: It's crucial to ensure that all information on the form is legible. Illegible handwriting can cause significant delays in the processing of the form.
  2. Using abbreviations: The instructions specify that no abbreviations should be used. This includes addresses, names of facilities, and descriptions of in-service training completed. Abbreviations can lead to misunderstandings or queries, adding unnecessary time to the certification process.
  3. Missing the submission deadline: The form, along with the appropriate fee, must be submitted by March 31. Late submissions may result in delays, additional fees, or removal from the QMA registry, which requires further steps to reinstate certification.
  4. Failing to provide mandatory information: Certain fields on the form are marked with an asterisk (*) to indicate they are mandatory. Leaving these fields blank will result in the form being returned.
  5. Not including proof of the required in-service education hours: QMAs must complete at least six (6) hours per year of in-service education related to medication or medication administration. Neglecting to provide documentation or details of these hours can lead to certification issues.
  6. Overlooking the signature: A common mistake is failing to sign the form. The QMA's signature is necessary to verify the accuracy of the information provided and to apply for re-certification.
  7. Incorrect payment method or amount: The form specifies that a $10.00 check or money order payable to the Indiana State Department of Health must accompany the submission. Using incorrect payment methods or amounts can prevent the form from being processed.

To avoid these mistakes, it's recommended that QMAs review their forms thoroughly before submission, ensuring all information is accurate and complete. Double-checking that the form is signed, accompanied by the correct fee, and submitted on time can aid in a smooth recertification process.

In addition to these common errors, it's beneficial for QMAs to keep copies of all documents submitted for their records. Should any questions arise from the Indiana State Department of Health, having these documents readily available can expedite resolutions. Furthermore, maintaining up-to-date knowledge on the requirements for certification and recertification ensures that QMAs can continue to provide quality care to their patients without disruption.

Documents used along the form

Completing the Indiana Department Annual In-Service Training form is a crucial step for Qualified Medication Aides (QMAs) in Indiana to maintain their certification and ensure they are up-to-date with the latest practices in medication administration. However, this form is often accompanied by other important documents that play a vital role in the certification and recertification process, ensuring that professionals are fully equipped and recognized for their skills and knowledge.

  • Certification and Renewal Application: This document is used for the initial certification of new QMAs and for the renewal of existing certifications. It's essential for verifying the applicant's eligibility and ensuring that all the necessary requirements have been fulfilled for certification or recertification.
  • Proof of Continuing Education: Documented proof of continuing education is necessary to verify that a QMA has completed the required annual in-service training hours. This may include certificates of completion from approved training programs or transcripts from educational institutions.
  • Verification of Employment: This form provides evidence that the QMA is currently employed in a facility that requires the use of their qualification. It usually needs to be signed by the employer and can be used to verify the practical experience of the QMA.
  • Fee Payment Receipt: When the form and fee are submitted for recertification, a receipt is typically issued as proof of payment. Retaining this receipt is crucial for the QMA in case of any discrepancies or issues with the recertification process.

Together, these documents form the backbone of the certification and recertification process for Qualified Medication Aides in Indiana. They ensure that QMAs are not only knowledgeable and up-to-date on the latest medication administration practices but are also held to a high standard of professional accountability. Understanding and properly managing these forms is essential for QMAs to successfully navigate their certification requirements and continue contributing to the healthcare field.

Similar forms

The Indiana Department Annual Inservice form, also known as the Qualified Medication Aide Record of Annual In-Service Training, dovetails in function and structure with several other crucial documents within healthcare and professional certification spheres. One such document is the Continuing Education Unit (CEU) Tracking Form commonly used by licensed healthcare professionals.

Firstly, the Continuing Education Unit (CEU) Tracking Form serves a parallel purpose by documenting ongoing professional education, which is essential for maintaining licensure and ensuring high standards of care are met. Both documents require detailed entries about educational activities, including dates, topics, duration, and instructor validation. Additionally, both emphasize accountability in professional development, a key component in both healthcare delivery and quality assurance. Where they converge most notably is in their role as tangible proof of compliance with regulatory bodies, underscoring a commitment to up-to-date practice and patient safety.

Another analogous document is the Professional Development Record often utilized within various fields to monitor the progress and completion of training programs. Like the Indiana Department form, this record tracks the specifics of each training session, including the provider's name, topic covered, and hours completed. The fundamental similarity lies in their shared objective of fostering continuous learning and skill enhancement. These documents not only serve as personal archives for individual professionals but also play a crucial role in audits and evaluations, ensuring that all practitioners meet the current standards required in their respective fields.

Lastly, the form aligns closely with the Annual Performance Review documents that are prevalent in many sectors, including healthcare. Although performance reviews are broader in scope, covering various aspects of an employee's output and conduct, they also include a section on professional development activities similar to the in-service training records. Both forms are instrumental in identifying areas for growth, setting objectives for the forthcoming period, and validating competencies. Ensuring that employees engage in ongoing education and training directly impacts the quality of service and operational excellence, making these documents critical for both personal and organizational development.

Dos and Don'ts

When it comes to filling out the Indiana Department Annual In-Service form, there are certain practices that can streamline the process and ensure accuracy, as well as common pitfalls to avoid. Following these guidelines can help you maintain compliance and facilitate the recertification of your Qualified Medication Aide (QMA) status.

Do's

  • Print or type clearly: To ensure all information is readable and there are no delays due to illegible handwriting.
  • Avoid abbreviations: Writing out terms in full helps avoid confusion and ensures clarity in your submission.
  • Keep track of deadlines: Make note of the March 31 submission deadline and aim to submit well in advance to avoid any last-minute issues.
  • Maintain documentation: Keep a personal copy of all in-service education documentation in case there are any discrepancies or your submission is lost.
  • Ensure your CNA status is current: Since your Certified Nursing Assistant (CNA) expiration date is pertinent to your QMA certification, confirm its status before submitting the form.

Don'ts

  • Don't wait until the last minute: Delaying your submission can lead to unnecessary stress and potentially missing the deadline.
  • Don't forget to include the fee: Whether you're including a check or money order, or you've paid online, ensure you've marked the appropriate payment indication on the form.
  • Don't skip mandatory fields: If required information is missing, your form will be returned, delaying your recertification process.
  • Don't overlook the in-service education content: Verify that your annual in-service education is relevant to medication administration or the additional approved tasks if applicable to your facility's policy.
  • Don't ignore contact information: If you have questions or need clarification, reach out to the provided contact emails or phone numbers.

By adhering to these guidelines, you can ensure a smoother process in maintaining your QMA certification, ultimately supporting your professional responsibilities and growth within the Indiana State Department of Health's regulatory framework.

Misconceptions

When it comes to the Indiana Department Annual In-Service form, there are quite a few misconceptions floating around. It's easy to get tangled up in hearsay and outdated information. Let's clear up some of the common misunderstandings:

  • It's optional to complete the form every year. This is not true. The form and the accompanying in-service education are mandatory for Qualified Medication Aides (QMAs) every year to ensure their certification remains valid.

  • Any type of in-service training counts towards the hour requirement. Actually, the in-service education must specifically relate to medication administration. This means training topics must be directly connected to medication or its administration, including practices like G-tube/J-tube medication administration, hemoccult testing, and blood glucose testing if applicable to the QMA’s duties.

  • The training hours can carry over from one year to the next. Each QMA must complete at least six hours of in-service education annually. There is no carryover of hours - each year starts anew with zero hours towards the requirement.

  • The form can be submitted without the fee if done so online. Regardless of submission method, the form and the appropriate fee must be submitted together by March 31 of each year. Failure to do so may result in additional fees or removal from the QMA registry.

  • Payment options are limited to checks or money orders. While the instructions specify a check or money order payable to the Indiana State Department of Health, it's always wise to check for updated payment options or online payment availability directly with the department.

  • There's plenty of time after March 31 to submit the form without repercussions. Late submissions face the risk of additional fees and can even lead to the QMA being removed from the registry. It's critical to meet the deadline to avoid complications.

  • If removed from the registry, a QMA just needs to pay a late fee to be reinstated. Reinstatement after removal requires more than a late fee. The QMA must complete an approved QMA course and pass the competency test within three attempts.

  • You can wait for the ISDH to contact you about recertification. It's the responsibility of the QMA to track expiration dates, complete in-service hours, and submit documentation on time. Relying on a reminder from ISDH could lead to missed deadlines.

  • In-service requirements are the same for all QMAs regardless of their roles. In-service education must cover medication administration but can also include additional specific training such as G-tube/J-tube administration, hemoccult testing, and finger stick blood glucose testing, depending on the QMA’s role and facility policy.

Understanding the specifics of the annual in-service training requirements can help QMAs avoid potentially career-impacting mistakes. It's always best to go directly to the source, like official ISDH communications or their website, for the most current and accurate information.

Key takeaways

Understanding the requirements and proper completion of the Indiana Department Annual Inservice form is crucial for Qualified Medication Aides (QMAs) to maintain their certification and ensure compliance with state regulations. Here are the key takeaways:

  • The form requires clear, legible printing or typing, with no abbreviations, to ensure all information is accurately captured and understood.
  • It is mandatory to submit the form and the associated fee to the Indiana State Department of Health (ISDH) by March 31st each year to avoid penalties or loss of certification.
  • QMAs carry the responsibility for completing at least six hours of annual in-service education that directly relates to medication and/or its administration. This includes specific procedures if the facility's policy allows, such as administration via G-tube/J-tube, hemoccult testing, and finger stick blood glucose testing.
  • An important compliance measure is that QMAs must also ensure that their Certified Nursing Assistant (CNA) status is current, as this is a prerequisite for maintaining their QMA certification.
  • The form, along with the $10.00 fee (check or money order payable to Indiana State Department of Health), should be sent specifically to the ISDH Cashier's Office at the provided address, highlighting the importance of proper submission procedures.
  • Late submissions or failures to meet the renewal requirements can lead to additional fees or removal from the QMA registry, emphasizing the necessity of timely compliance to avoid complications in certification status.
  • For the recertification or reinstatement process, accurate documentation of in-service education is crucial. QMAs must ensure all parts of the form are completed, including mandatory fields denoted with an asterisk (*), to confirm they have met the educational criteria for the year.

Each of these elements plays a pivotal role in the certification and recertification process for QMAs, signifying the importance of understanding and properly managing the completion and submission of the Indiana Department Annual Inservice form. Compliance ensures not only adherence to regulations but also the continued competence and certification of QMAs in Indiana.

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