Form 5509 Nar PDF Details

The Texas Nurse Aide Registry Form 5509-NAR, a crucial document dated September 2021, serves as an employment verification tool for nurse aides within the state. This form, structured to facilitate the annual report requirements for nursing and skilled nursing facilities, mandates the listing of all nurse aides employed since the last report, who meet specific renewal prerequisites. Critical instructions include completing employer information, not allowing aides to fill out the form for their facility, adhering to submission guidelines, and properly formatting employment dates. Additionally, it enforces the mandatory submission of this form once every 12 months to ensure compliance with Texas Standards for Nurse Aides, per 26 TAC §556.9. Email submission to the Texas Nurse Aide Registry is required, alongside verification that listed employees have met recertification needs such as completing 24 hours of in-service education biennially, annual infection control training, absence from the Employee Misconduct Registry (EMR), and lack of disqualifying criminal convictions. Should a facility be unable to verify these requirements, further verification through Form 5506-NAR is mandated. Detailed in its scope, Form 5509-NAR embodies a comprehensive mechanism for maintaining the standards of nurse aide employment and ensuring the continued qualification and certification of aides within these facilities.

QuestionAnswer
Form NameForm 5509 Nar
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnurse aide form 5509 nar, nurse aide employment verification form, 5509 nar, form 5509 na printable

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Form 5509-NAR

September 2021-E

Texas Nurse Aide Registry

Facility Nurse Aide Employment Verification

General Instructions

1.Complete facility/employer information requested at the bottom of this page. Repeat the facility/employer name and date of completion on each additional page submitted. A nurse aide may not complete this form for the facility/ employer.

2.List all nurse aides who have been employed with you since your last annual report that met the renewal requirements below. Nursing facilities (NF) and skilled nursing facilities (SNF) are required to submit a list of nurse aide employees on an annual basis, per Texas Standards for Nurse Aides, 26 TAC §556.9.

3.Do not submit Form 5509-NAR (complete list of employees) more than once in a 12-month period.

4.Dates of employment must be indicated in mm/dd/yyyy format. If an individual is still employed, do not leave end date blank. Indicate with either ‘present’ or ‘current’ in the end date box.

5.You may electronically duplicate the format of this document; however, you must include all fields/columns in the order presented on this document.

6.Email the completed form to the Texas Nurse Aide Registry at: nurseaideregistry@hhs.texas.gov.

Facility or Employer Name:

Facility or Employer's Mailing Address:

Facility Representative Name and Title:

Area Code and Phone No.:

Area Code and Fax No.:

Signature – Facility Representative

Date Form Completed

I certify that all individuals listed on this form meet/met the following recertification requirements.

•Has completed 24 hours of in-service education in the past two years.

•Has completed an HHSC course in infection control and proper use of personal protective equipment (PPE) every year.

•Is not listed as unemployable on the Employee Misconduct Registry (EMR).

•Has not been found to have a conviction of a criminal offense listed in Texas Health and Safety Code §250.006.

Signature – Facility Representative

Date Form Completed

If the facility or employer cannot verify the requirements above, then the facility or employer and the nurse aide must complete Form 5506-NAR, Employment Verification.

Facility or Employer Name:

Form 5509-NAR

Page 2 / 9-2021-E

Date Form Completed:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

How to Edit Form 5509 Nar Online for Free

Having the purpose of allowing it to be as quick to use as it can be, we built the PDF editor. The process of filling out the 5509 nar form will be quick for those who keep to the next actions.

Step 1: Hit the "Get Form Now" button to begin the process.

Step 2: You are now allowed to change 5509 nar form. You have many options thanks to our multifunctional toolbar - you'll be able to add, erase, or modify the content material, highlight the selected components, and carry out other commands.

To get the document, provide the content the software will request you to for each of the following parts:

portion of fields in nurse aide form 5509 nar

In the area Facility or Employer Name, Date Form Completed, Last Name, First Name, Social Security No, Nurse Aide No, Start Date, Address, City State and ZIP Code, End Date, Last Name, First Name, Social Security No, Nurse Aide No, and Start Date write down the information that the platform demands you to do.

Entering details in nurse aide form 5509 nar stage 2

The application will demand for more information to be able to effortlessly fill out the box Last Name, First Name, Social Security No, Nurse Aide No, Start Date, Address, City State and ZIP Code, End Date, Last Name, First Name, Social Security No, Nurse Aide No, Start Date, Address, and City State and ZIP Code.

part 3 to filling out nurse aide form 5509 nar

Identify the rights and responsibilities of the sides in the field Address, City State and ZIP Code, and End Date.

step 4 to filling out nurse aide form 5509 nar

Step 3: Click the "Done" button. You can now transfer your PDF form to your device. As well as that, you may forward it by means of electronic mail.

Step 4: In order to avoid any sort of troubles as time goes on, you should make at the very least a couple of copies of your document.

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