Embarking on a career as a Qualified Medication Aide (QMA) in Indiana requires a thorough preparation and adherence to specific protocols. One pivotal aspect of this journey involves completing and submitting the State Form 17213, a document facilitated by the Indiana State Department of Health designed for long-term care practitioners. This form serves a multifaceted purpose, including capturing the applicant's personal information, detailing the requisite education and practicum hours, and ultimately, verifying the applicant's qualifications. Comprising various sections, the form requests detailed information from the applicant, such as legal identity and contact information, alongside a privacy notice regarding the voluntary provision of Social Security Numbers. Education and practical training sections further require course details, facility affiliations, instructor validations, and verification of successful completion. Additional sections solicit information regarding the candidate's status, necessary documentation for testing eligibility—highlighting the $60 money order fee requirement—and procedure for documenting test results. This comprehensive form, requisite for potential QMAs, underscores the rigorous standards set forth by Indiana's health regulatory authorities to ensure qualified, competent professionals enter the field.
| Question | Answer |
|---|---|
| Form Name | State Form 17213 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | 17213 empire auto parts browser form |
