Edit, Download, and Sign the New Mexico Nursing Assistant Registry Renewal Form
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How do I fill this out?
Filling out this form requires careful attention to detail. Start by completing Section 1 with your personal information. Ensure that your employer fills out Section 2 accurately before submission.
How to fill out the New Mexico Nursing Assistant Registry Renewal Form?
1
Complete Section 1 with your information.
2
Request your employer to fill out Section 2.
3
Mail the completed form to Prometric for Medicaid-approved facilities.
4
Include the renewal fee for non-Medicaid facilities.
5
Make sure to keep a copy of your completed form.
Who needs the New Mexico Nursing Assistant Registry Renewal Form?
1
Nurse aides needing renewal of their certification.
2
Employers verifying nurse aides' work history.
3
Healthcare facilities ensuring compliance with regulations.
4
Individuals transitioning between nursing jobs.
5
New Mexico residents maintaining their medical licenses.
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1
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What are the instructions for submitting this form?
Submit the completed form by mailing it to Prometric at the provided address. Be sure to include any required fees, along with the documentation verifying your work experience. If submitting via credit card, provide the necessary information on the form.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, ensure your form is submitted at least 30 days before your certification expiration. Late submissions (more than 60 days after expiration) will not be processed.
What is the purpose of this form?
This form serves to document and verify the work experience of nurse aides in New Mexico. It is essential for the renewal of certification, allowing nurse aides to continue their professional responsibilities. Accurate completion ensures compliance with state regulations and supports the integrity of the nursing profession.
Tell me about this form and its components and fields line-by-line.
- 1. Last Name: The family name of the nurse aide.
- 2. First Name: The given name of the nurse aide.
- 3. Street Address: The current residence of the nurse aide, including any applicable P.O. Box.
- 4. City: The city where the nurse aide resides.
- 5. NMCNA Certification #: The certification number of the nurse aide in the New Mexico Nurse Aide Registry.
- 6. Signature: A signed confirmation from the nurse aide affirming the accuracy of information.
What happens if I fail to submit this form?
Failure to submit this form may lead to the expiration of your certification. This could result in ineligibility to work as a nurse aide in New Mexico. You must complete the renewal process within the designated timeframe to avoid complications.
- Expired Certification: Operating with an expired certification may lead to disciplinary actions or job loss.
- Verification Issues: Inability to verify work experience could hinder future employment opportunities.
- Non-compliance Penalties: Working without a valid certification may result in legal penalties.
How do I know when to use this form?
- 1. Certification Renewal: Submit this form as part of the process to renew your nurse aide certification.
- 2. Employment Verification: Employers may require this form to verify the qualifications of nurse aides.
- 3. Regulatory Compliance: Healthcare facilities need this to meet state regulatory requirements.
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You can generate a share link and share your PDF with others via email or social media.
Is there a fee for submitting this form?
A non-refundable fee of $26.25 is required for renewal submissions.
What details do I need for Section 1?
You will need to provide your full name, address, and contact information in Section 1.
How long does the renewal process take?
Typically, the renewal process may take a few weeks depending on your submission.
What should I do if my employer won't verify my employment?
If your employer refuses to complete Section 2, you can submit pay stubs or a W-2 for verification.
Can I fill out this form electronically?
Yes, you can use PrintFriendly to fill out the form electronically before printing.
What if my certification has expired?
You will need to consult the renewal guidelines and possibly complete additional requirements.
Where do I send my completed form?
Mail your completed form to Prometric at the address specified in the instructions.
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