State 49937 Form in PDF

What is the purpose of the State Form 49937?

The State Form 49937 is designed for the renewal of Certified Nurse Aide (CNA) registration within the state of Indiana. Its primary function is to allow employers to report that a CNA has actively worked, providing "nursing or nurse-related services" for at least one eight-hour shift over a consecutive 24-month period. Successfully submitting this form to the Indiana State Department of Health's Nurse Aide Registry (NAR) ensures the CNA's registration is renewed for another two years.

Who needs to complete the State Form 49937?

This form must be filled out by the employer of a Certified Nurse Aide (CNA) in Indiana. The employer is responsible for reporting the CNA's employment and confirming that the CNA has met the minimum work requirement for renewal of their registration.

What information is required when filling out the State Form 49937?

The form requires detailed information about the CNA, including their name, address, telephone number, date of birth, social security number, CNA registration number, dates of hire and termination (if applicable), job title, and the number of hours worked. Additionally, the form requests information about the employer, including the director or RN's name, the name and address of the health care facility, facility number, and telephone number. Lastly, the director or RN must sign the form, attesting to the accuracy of the information provided.

How often must State Form 49937 be submitted to the ISDH?

Employers must submit the State Form 49937 for each CNA every two years, corresponding to the renewal cycle of the CNA's registration. It's important to ensure that the form is filled out and submitted in a timely manner to avoid any lapses in the CNA's registration.

What happens if a CNA does not meet the work requirement for renewal?

If a CNA fails to meet the minimum work requirement of completing at least one eight-hour shift in a 24-month consecutive period, their registration may not be renewed. This could affect their eligibility to work as a CNA in the state of Indiana. Employers or CNAs with specific questions regarding exceptions or extenuating circumstances should contact the Indiana State Department of Health directly.

Where should the completed State Form 49937 be sent?

The completed form should be submitted to the Indiana State Department of Health's Nurse Aide Registry (NAR). For specific mailing or electronic submission instructions, it is advisable to visit the official ISDH website or contact the NAR directly to ensure compliance with current procedures.

Can a CNA submit the State Form 49937 on their own behalf?

No, the form is designed to be completed and submitted by the employer. This is because the employer must attest to the CNA's employment and verify that the work requirement has been met. CNAs should ensure their employer is aware of the renewal requirements and the need to submit the form.

What should an employer do if they make an error on the State Form 49937?

If an employer discovers an error on the State Form 49937 after submission, they should promptly contact the Indiana State Department of Health's Nurse Aide Registry for guidance on correcting the information. It may be necessary to submit a revised form or additional documentation depending on the nature of the error.

Filling out the State 49937 form, crucial for the renewal of a Certified Nurse Aide (CNA) registration in Indiana, is a task that often appears straightforward but can be fraught with errors. Mistakes on this form can cause delays or even prevent the renewal of a CNA's certification, impacting their ability to work.

First and foremost, a common error is the omission of essential information, leading to incomplete forms. Every field in the State 49937 form is important and requires attention. Specific areas that are frequently skipped include:

1. The CNA's complete address and telephone number.
2. The accurate CNA registration number.
3. Dates of hire and, if applicable, termination.

Inaccurate reporting of the number of hours worked is another mistake that can significantly impact the renewal process. The form requires verification that the CNA has worked for at least 8 hours in a completed 24-month period. Failure to accurately report these hours or inflating them can lead to issues with the renewal.

Additionally, errors in the agency identification section are common. This includes incorrect or incomplete information about the health care facility, such as:

• The full name and address of the facility.
• A mismatch between the facility number and telephone number.

Another error involves the director or registered nurse (RN) responsible for the form failing to sign or date the attestation section. This section is critical as it serves as an official acknowledgment from the facility that the information provided is accurate and true.

Lastly, overlooking the importance of double-checking the form for typos, especially in crucial identification numbers like the Social Security number or CNA registration number, can jeopardize the renewal process. Such mistakes can lead to misidentification or processing delays, as they may not match the official records.

It is imperative to approach the State 49937 form with meticulous attention to detail. Ensuring the complete and accurate filling of this form is not only a requirement but a responsibility to the CNA seeking renewal. Avoiding these common mistakes can streamline the renewal process, preventing unnecessary hurdles in a CNA's professional journey.

When completing the State Form 49937 for the renewal of a Certified Nurse Aide (CNA) registration, several additional forms and documents are commonly used to ensure compliance with the Indiana State Department of Health's requirements. These documents support the renewal process by providing necessary information about the CNA's employment history, training, and legal eligibility for work.

• Employment Verification Form: This document verifies that the CNA has been employed and has performed nursing or nurse-related services for at least 8 hours in a 24-month consecutive time period. It includes details such as the employer's name, the CNA's dates of employment, and a description of work performed.
• Continuing Education Certificates: CNAs are required to complete continuing education units (CEUs) to maintain their certification. These certificates provide proof of completed coursework relevant to the CNA's field of work, ensuring they stay informed about best practices in nursing care.
• Criminal Background Check: A current criminal background check may be required to ensure the CNA's eligibility for renewal. This check aims to identify any criminal history that might disqualify the CNA from working in a healthcare setting.
• First Aid and CPR Certification: Documents proving that the CNA holds current certifications in First Aid and CPR are often required. These certifications demonstrate that the CNA is prepared to provide critical support in emergency situations.

Together with the State Form 49937, these documents create a comprehensive application package. This package not only verifies the CNA's continuous employment in providing direct care but also confirms their ongoing commitment to meeting the educational and legal requirements necessary for providing quality care to patients. By assembling all required documentation, CNAs and their employers can facilitate a smooth renewal process, ensuring no lapse in the CNA's certification and eligibility to work.

The State 49937 form is similar to several other documents required in the healthcare and certification fields. Each of these documents has its own specific use but shares common features with the State 49937 form in terms of purpose, required information, and the process of submission. Below are the documents it most closely resembles and the reasons why.

State 49934 Form - CNA Initial Certification: Similar to the State 49937 form, the Initial Certification form is used by Certified Nurse Aides in Indiana. While the 49937 form is for renewal, the 49934 form is for those applying for certification for the first time. Both require personal information about the CNA, including their name, address, date of birth, and Social Security number. Additionally, each form requires official verification from a healthcare facility or employer to attest to the qualifications or ongoing competency of the CNA.

Form I-9, Employment Eligibility Verification: Although Form I-9 is used across all industries in the United States for verifying the identity and employment authorization of individuals hired for employment, it shares a similar necessity for accurate and verified personal information with the State 49937 form. Both forms require the employer to attest to the accuracy of the information provided, and both play a vital role in regulatory compliance. The major difference lies in their scope; Form I-9 is broader, applying to any employee, whereas the State 49937 form is specific to Certified Nurse Aides.

Healthcare Facility Staffing Report: This type of document, while not a single standardized form, is common in healthcare settings. Facilities often must report the credentials, work hours, and specialties of their staff to various regulatory and accrediting bodies. Similar to the State 49937 form, these reports help ensure that staff members, like CNAs, are properly credentiated and actively fulfilling their roles. Both types of documents require detailed information about the healthcare professionals and verification from the facility of the professional’s active status.

Overall, though the specific uses and fields of application vary, these documents share a core function with the State 49937 form: ensuring that professionals in sensitive and critical positions are appropriately qualified, active, and in good standing. This underlying similarity underscores the importance of such forms in maintaining standards and protecting the well-being of those served by these professionals.

When completing the State 49937 form, which is essential for the renewal of a Certified Nurse Aide (CNA) registration in Indiana, compliance with specific guidelines ensures accuracy and prompt processing. This form, a crucial document for maintaining the validity of a CNA's credentials, requires attention to detail and an understanding of the requisites. The following points outline the dos and don'ts while filling out this form:

• Do ensure that all information provided is accurate and current. This includes personal details of the CNA, employment history, and the number of hours worked.
• Do verify the CNA's registration number and social security number for correctness to avoid any discrepancies that could delay the renewal process.
• Do have the form signed by a Director or Registered Nurse (RN) to attest to the truthfulness of the submitted information, as this serves as a formal acknowledgment of the CNA's service period.
• Do contact the Indiana State Department of Health's Nurse Aide Registry (NAR) if you have any questions or need clarification regarding the form's requirements to ensure compliance and completeness.
• Don't leave any required fields blank. Incomplete forms may result in processing delays or rejection of the application for renewal.
• Don't guess information. If uncertain about specific details, such as the exact date of hire or termination, seek accurate data from employment records before submission.
• Don't submit the form without reviewing it for potential errors. Taking the time to double-check entries can prevent unnecessary complications.
• Don't disregard the deadline for submission, as failing to renew on time may lead to the CNA's registration being deemed invalid, affecting their eligibility to work.

Adherence to these guidelines when filling out the State 49937 form is crucial for the smooth renewal of a CNA's registration. By doing so, healthcare facilities can ensure that their staff remains compliant with state regulations, thereby maintaining the quality and continuity of care provided to patients.

Despite its clear intention and design, numerous misunderstandings surround the State 49937 form. These misconceptions impede the accurate and efficient processing of Certified Nurse Aide (CNA) renewals within Indiana. The following list aims to clarify these common errors.

• State 49937 is applicable in all states. This form is specific to Indiana, under the direction of its State Department of Health-Division of Long Term Care. Each state has its own procedures and documents for CNA renewal.
• The form is for initial CNA certification. In reality, State Form 49937 is designed for the renewal process of a CNA's certification, not for the initial certification.
• Renewal requires a fee. There is no mention of a fee associated with this renewal form. It primarily requires information verification from the employer.
• Employers are not involved in the renewal process. Contrary to this belief, the form clearly states that employers must report a CNA's work hours to the Indiana State Department of Health (ISDH) Nurse Aide Registry (NAR) for renewal.
• The form needs to be completed by the CNA. While the form pertains to the CNA's renewal, it is the employer, specifically a Director or RN, who must complete and attest to the accuracy of the information.
• Any type of work qualifies for renewal. The form stipulates that the CNA must have performed “nursing or nurse-related services” for at least an eight-hour shift within a 24-month period, specifying the kind of work that qualifies for renewal.
• Renewal is automatic upon submission. The process involves verification and approval by the ISDH NAR. The mere submission of the form does not guarantee renewal.
• Renewal covers only one year. CNA certifications are renewed for a two-year period upon successful completion and submission of this form, extending beyond the one-year period that some might assume.
• The form is only for healthcare facilities. While it is designed for CNAs employed by healthcare facilities, the fundamental requirement is that the CNA has performed qualifying work. There is not an exclusive mandate that this work occur within a traditional healthcare facility as long as the employment meets state regulations.

Clearing up these misconceptions is crucial for ensuring that CNAs maintain their certification status effectively. It also enhances the understanding of employers and CNAs alike regarding the renewal process governed by the Indiana State Department of Health-Division of Long Term Care.

To effectively handle the nuances of the State Form 49937, often associated with Certified Nurse Aide (CNA) renewal in Indiana, it's important to understand its purpose and the required steps for its completion. This form plays a critical role in ensuring CNAs maintain their registered status and are eligible to work in health care settings. Below are key takeaways to guide both CNAs and their employers through the submission process.

• Annual Notification: Employers are mandated to notify the Indiana State Department of Health (ISDH) Nurse Aide Registry (NAR) annually if a CNA has completed at least one eight-hour shift in a 24-month consecutive period.
• Details Matter: When filling out the form, it is essential to provide accurate and complete information regarding the CNA's employment and personal details, including periods of work and job function.
• Renewal Timeline: Successful form submission ensures the renewal of a CNA's certification for another two years, allowing continued employment in nursing or nurse-related services.
• Agency Responsibility: It is up to the employer or the agency's director or registered nurse (RN) to attest to the accuracy of the information provided on the form, underlining the importance of the role in maintaining accurate employee records.
• Proof of Services: By completing the form, the employer verifies that the CNA has indeed performed nursing or nurse-related services for the minimum required hours, reinforcing the importance of record-keeping.
• Expiration Awareness: Keeping track of the CNA's expiration date is crucial. This form acts as a preventive measure against letting a certification lapse, which can interrupt the CNA's ability to work.
• Contact Information: The form requires detailed contact information for both the CNA and the employing health care facility, ensuring clear lines of communication for future correspondence from the ISDH.
• Office Use Section: This part of the form is reserved for official use by the ISDH, indicating the processed expiration and renewal dates, which are key to maintaining an up-to-date status in the Nurse Aide Registry.
• Detailed Job Description: Specifying the number of hours worked and the job function performed is essential for the renewal process, providing clear evidence of the CNA’s active role in patient care.
• Signature and Accuracy: The form must be signed by the director or RN of the healthcare facility, attesting to the truth and accuracy of all the information provided, which underscores the legal importance of the document.

Understanding and adhering to these guidelines ensures a smooth renewal process for CNAs, maintaining their eligibility to provide critical care in various health care settings across Indiana.