MEDICAL

Instructions:
• Provide the information requested in (1) through (9) below.
• Have your current or former nurse aide employer complete the back of this form (10) through (14).
• The employer verifying employment history must also provide a letter on Facility/Agency letterhead [see (14)]
• Return the completed renewal form with the Facility/Agency letter and a $20 money order made payable to Prometric.

This renewal fee is a nonrefundable processing fee. Mail to address provided on the back of this form.

Eligibility for Renewal:
You are eligible to renew your certificate if you have worked as a Certified Nurse Aide (CNA) or Unlicensed Assistive Personnel (UAP) in a traditional or nontraditional health care facility, licensed by the state of Michigan and/or certified by the Federal Government, performing nursing or nursing -elated services for pay under the supervision of a registered nurse for at least eight (8) consecutive hours within the immediate 24 month period prior to your current registry document expiration date (or within the 60-day grace period). Note: Nurse Aides flagged on the registry for resident abuse, neglect or misappropriation of property are not eligible for renewal.

A letter must be attached to this renewal form on Facility/Agency letterhead documenting the current or former employment of the nurse aide with your facility/agency. The letter must be signed by one of the following authorized personnel: Administrator/Asst. Administrator, Director of Nurses/Assistant Director or Nurses, Staff Development Coordinator, Scheduling Coordinator or Director of Human Resources. If the nurse aide was employed with a staffing agency providing temporary staffing in a long term care facility, the letter must include the name and address of the Long Term Care Facility where the nurse aide most recently worked. The letter must also include the most recent date the nurse aide worked in this capacity.

(Read More on Free Ebook at PDF Format)

Download MICHIGAN NURSE AIDE REGISTRY RENEWAL FORM.pdf

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Tags: Certified Nurse Aide | Nurse Aide

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