Six (6) hours of inservice training, directly related to medication, medication administration, and the QMA scope of practice, must be completed for the 2-year recertification period.
Insulin: for insulin administration certified QMAs, one (1) additional hour of inservice training, directly related to insulin administration, must also be completed.
Inservices: only inservices related to medication, medication administration, QMA scope of practice, and insulin administration should be included on this form.
Completing: please type or print clearly in black ink. Electronic signatures are acceptable.
| Question | Answer |
|---|---|
| Form Name | State Form 51654 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 83 |
| Avg. time to fill out | 14 min |
| Edition | R7 / 9-26 |
| Issuing agency | Indiana Department of Health |
| Other names | State Form 51654, 51654, Form 51654, Indiana State Form 51654, QMA inservice form, QMA Record of Annual Inservice Training |
| Official source | State Form 51654 (Rev R7 / 9-26), Indiana Department of Health |
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