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Blank South Carolina Nurse Aide PDF Template

The South Carolina Nurse Aide form is a comprehensive application designed for individuals seeking to be listed on the North Carolina Nurse Aide I Registry through reciprocity. This procedure ensures that applicants who are already active and in good standing on another state's nurse aide registry can work in North Carolina, provided they meet specific eligibility criteria and submit the required documentation. To begin the application process and join the registry, fill out the form by clicking the button below.

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Blank South Carolina Nurse Aide PDF Template

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Navigating the complexities of working as a nurse aide across state lines involves a detailed understanding of various forms and requirements, one of which includes the South Carolina Nurse Aide form by the North Carolina Department of Health and Human Services. This pivotal document serves as a Nurse Aide I Registry Reciprocity Application, setting a structured pathway for nurse aides seeking to be recognized on the North Carolina registry. The form, comprehensive in its scope, mandates applicants to tick off several eligibility criteria before proceeding with the application. Individuals must confirm their standing in another state's nurse aide registry, ensure they have no recorded findings of misconduct, and verify their employment in a nursing or nursing-related capacity within the last two years. Additionally, possession of a social security card and an unexpired government-issued identification, alongside successful completion of a state-approved nurse aide training program, is required. Personal information, employment history detailing specific types of permissible employment settings, and a background free of abuse or neglect allegations form the bedrock of information required to facilitate this transition. The application process is further detailed with instructions on using black or blue ink for clarity and options for submission by mail or fax, stressing the importance of accuracy and completeness for prospective applicants.

Preview - South Carolina Nurse Aide Form

North Carolina Department of Health and Human Services

Division of Health Service Regulation

Health Care Personnel Education and Credentialing Section

Phone: 919-855-3969

NURSE AIDE I REGISTRY RECIPROCITY APPLICATION

DHSR Has 10 Business Days from Date of Receipt to Review the Application.

INSTRUCTIONS:

▪Review Part 1 below and determine if you meet the eligibility requirements to be listed on the North Carolina Nurse Aide I Registry.

▪If you meet the eligibility requirements, then complete and submit all pages of the application (pages 1 through 6) and any required supportive documentation. Incomplete applications will not be processed.

▪

Please use black or blue ink only. Other ink colors are not be readable via fax. Return completed application by mail or fax.

oMailing Address: 2709 Mail Service Center, Raleigh, NC 27699-2709

o Fax Number: 919-733-9764

Do Not Submit More Than One (1) Application Unless Instructed by DHSR.

PART 1: DETERMINE ELIGIBILITY

Consistent with Rule 10A NCAC 13O .0301, to be eligible to be listed on the North Carolina Nurse Aide I Registry, you must meet the five (5) criteria listed below.

1.You are listed as active and in good standing on another State registry of nurse aides.

o A temporary listing on a State registry of nurse aides will not be accepted.

2.You have no pending or substantiated findings of abuse, neglect, exploitation, or misappropriation of resident or patient property recorded on any State registry of nurse aides.

3.You have been employed as a nurse aide for monetary compensation consisting of at least a total of eight hours of time worked performing nursing or nursing-related tasks delegated and supervised by a Registered Nurse in the past two years (previous 24 consecutive months).

oIf you have not been employed as a nurse aide, then you are only eligible for reciprocity if you successfully passed a state-approved nurse aide I competency examination and was listed on the Nurse Aide I Registry in the State(s) of reciprocity in the past two years (previous 24 consecutive months).

oPrivate duty nurse aide employment type does not meet the eligibility requirements for reciprocity.

4.You have a social security card and an unexpired government-issued identification containing a photograph and signature.

oThe name listed on your social security card and unexpired government-issued identification containing a photograph and signature must match.

oThe name listed on both identifications must match the name listed on the nurse aide registry in the State(s)

of reciprocity.

oIf the names do not match, then you must submit documentation verifying any name changes (e.g., birth certificate, marriage license, divorce decree, notice of resumption of former name, etc.).

5.You completed a state-approved nurse aide training and competency evaluation program that meets the requirements of 42 CFR 483.152 or a state-approved competency evaluation program that meets the requirements of 42 CFR 483.154.

DHSR/HCPEC-4515 (Revised February 2021)

Page 1 of 6

PART 2: PERSONAL INFORMATION

▪

Answer all questions. Print legibly.

Include hyphens and suffixes in your legal name if applicable (No Nicknames).

First Name:

Middle Name:

Last Name:

Prior Name(s) (if applicable):

First Name:		Middle Name:			Last Name:

First Name:		Middle Name:			Last Name:


Gender:		Social Security Number:			Email Address:
		(include all 9 numbers)
□ MALE	□ FEMALE

Telephone Number:		Date of Birth:			Mother’s Maiden Last Name:
(include area code)
		_________/________/__________
		mm	dd	yyyy

Did You Serve in the Military?
□ YES	□ NO

Did You Work in a Military Occupational Specialty (MOS) Where You Performed Nursing or Nursing-Related Tasks?

□ YES □ NO □ I DID NOT SERVE IN THE MILITARY

Are You Currently Married to an Active Member of the Military or a Military Veteran?

□ YES □ NO

Mailing Address:

Street/PO Box:

City:

Zip Code:

Apt. #:

State:

County:

DHSR/HCPEC-4515 (Revised February 2021)

Page 2 of 6

PART 3: STATE-APPROVED NURSE AIDE I TRAINING & COMPETENCY EVALUATION PROGRAM

Answer both questions below.

□ YES	□ NO	Did You Complete a State-Approved Nurse Aide I Training Program that Consisted of At Least
□ YES	□ NO	75 Hours of Training?
		75 Hours of Training?

□ YES	□ NO	Did You Successfully Pass a State-Approved Nurse Aide I Competency Examination?
□ YES	□ NO

PART 4: NURSE AIDE I REGISTRIES

▪

Complete the table and questions below.

List all states that you have an active or expired nurse aide I registry listing. We will verify that you have no findings in the states where your listing is active or expired.

▪For all active listings, you must include, with this application, documentation verifying that each registry listing is active and in good standing in the State of reciprocity. The documentation should be dated within 30 calendar days before the date your application is received by the Department.

▪If your listing is active and you are currently working as a nurse aide in Alabama, then you must submit a signed letter from your current employer, on official company letterhead, indicating your nurse aide status is active in the state of Alabama.

State Name or	Is Your Registry			Original Issue Date:			Expiration Date:			Registry Certification or
Abbreviation:		Listing								Registration Number:
	Current/Active?
	□ YES		□ NO	______/______/______			______/______/______
	□ YES		□ NO	mm	dd	yyyy	mm	dd	yyyy

State Name or	Is Your Registry			Original Issue Date:			Expiration Date:			Registry Certification or
Abbreviation:		Listing								Registration Number:
	Current/Active?
	□ YES		□ NO	______/______/______			______/______/______
	□ YES		□ NO	mm	dd	yyyy	mm	dd	yyyy

State Name or	Is Your Registry			Original Issue Date:			Expiration Date:			Registry Certification or
Abbreviation:		Listing								Registration Number:
	Current/Active?
	□ YES		□ NO	______/______/______			______/______/______
	□ YES		□ NO	mm	dd	yyyy	mm	dd	yyyy


□ YES □ NO		Are You Listed on More Than Three State Nurse Aide Registries in an Active or Expired
		Status?

If you answered YES, then you must attach a separate sheet of paper providing the registry information for the States not listed in the table above.

DHSR/HCPEC-4515 (Revised February 2021)

Page 3 of 6

□ YES □ NO

Do You Have Any Pending or Substantiated Findings of Abuse, Neglect, Exploitation, or Misappropriation of Resident or Patient Property Recorded on Any State Registry of Nurse Aides?

If you answered YES to the question above, then list the States below.

States Where You Have a Pending or Substantiated Finding:

PART 5: EMPLOYMENT TYPE

▪Select the employment type where you performed nursing or nursing-related tasks delegated and supervised by a Registered Nurse in the past 2 years only (previous 24 consecutive months). Private duty nurse aide employment does not meet the eligibility requirements for reciprocity.

▪Select all that apply.

□ Adult/Family Care Home	□ Home Health/Home Care	□ Hospice

□ Hospital	□ Mental Health	□ Nursing Home

□ Other (please specify):

□ I Did Not Work as a Nurse Aide; I Successfully Passed a State-Approved Nurse Aide I Competency Evaluation
Program and Was Listed on the Nurse Aide I Registry in the State(s) of Reciprocity in the Past 2			Years (Previous
24 Consecutive Months).

PART 6: EMPLOYMENT HISTORY

▪Provide employment information where you performed nursing or nursing-related tasks delegated and supervised by a Registered Nurse in the past 2 years only (previous 24 consecutive months). Do not include private duty nurse aide employment.

▪If you did not work as a nurse aide, then leave blank.

FACILITY/AGENCY/EMPLOYER #1

Name:

Street/PO Box:

City:		State:		Zip Code:

Date of Hire as a Nurse Aide (month/year):		Last Reported Date of Employment as a Nurse Aide (month/year):
_____/_______		_____/_______
mm	yyyy	mm	yyyy

DHSR/HCPEC-4515 (Revised February 2021)				Page 4 of 6

□ YES □ NO

Is the Employer a Staffing Agency?

If you answered YES to the question above, then list the States below.

States Where You Worked for the Staffing Agency in the Past 2 Years (Previous 24 Consecutive Months):

□ YES	□ NO	Did You Work as a Nurse Aide for Monetary Compensation (i.e., For Payment or For Wages)
		in the Past 2 Years (Previous 24 Consecutive Months)?

□ YES	□ NO	Did You Work At Least 8 Hours Performing Nursing or Nursing-Related Tasks Delegated
		(i.e., Assigned) and Supervised by a Registered Nurse in the Past 2 Years (Previous 24
		Consecutive Months)?

If you answered YES to either question above, then provide the First and Last Name of the Registered Nurse. It is not required that the RN sign below.

Registered Nurse First Name and Last Name:

FACILITY/AGENCY/EMPLOYER #2

Name:

Street/PO Box:

City:			State:		Zip Code:

Date of Hire as a Nurse Aide (month/year):			Last Reported Date of Employment as a Nurse Aide (month/year):
_____/_______			_____/_______
mm	yyyy		mm	yyyy

□ YES □ NO		Is the Employer a Staffing Agency?
□ YES □ NO

If you answered YES to the question above, then list the States below.

States Where You Worked for the Staffing Agency in the Past 2 Years (Previous 24 Consecutive Months):

□ YES	□ NO	Did You Work as a Nurse Aide for Monetary Compensation (i.e., For Payment or For Wages)
		in the Past 2 Years (Previous 24 Consecutive Months)?

□ YES	□ NO	Did You Work At Least 8 Hours Performing Nursing or Nursing-Related Tasks Delegated
		(i.e., Assigned) and Supervised by a Registered Nurse in the Past 2 Years (Previous 24
		Consecutive Months)?

DHSR/HCPEC-4515 (Revised February 2021)			Page 5 of 6

If you answered YES to either question above, then provide the First and Last Name of the Registered Nurse. It is not required that the RN sign below.

Registered Nurse First Name and Last Name:

NOTE:

You must attach a separate sheet of paper if you had more than two employers where you performed nursing or nursing- related tasks delegated and supervised by a Registered Nurse in the past 2 years only (previous 24 consecutive months). Do not include private duty nurse aide employment.

PART 7: IDENTIFICATION

▪

Include a copy of your social security card with the submission of your application.

Include a copy of an unexpired government-issued identification containing a photograph and signature with the submission of your application.

▪The name listed on your social security card and unexpired government-issued identification containing a photograph and signature must match.

▪The name listed on both identifications must match the name listed on the nurse aide registry in the State(s) of reciprocity.

▪If the names do not match, then you must submit documentation verifying any name changes (e.g., birth certificate, marriage license, divorce decree, notice of resumption of former name, etc.).

▪Copies of identifications received by fax may not be readable. Please ensure copies of your identifications are readable before submitting your application. If your identifications are not readable, then you will be asked to re-submit the application and your identifications again.

The Following are Acceptable Government-Issued Identifications Containing a Photograph and Signature:

•Current, non-expired driver’s license (or expired driver’s license and temporary permit)

•U.S. government-issued Military I.D.

•State-issued identification card

•Passport (US or foreign, current, non-expired)

•Current, non-expired federal-issued employment authorization document (EAD) photo identification card

•Alien registration card

PART 8: APPLICANT SIGNATURE

I certify that all the information provided in this application is true and complete. I understand that if the information I have provided in this application is found to be fraudulent, then my listing will be removed from the North Carolina Nurse Aide I Registry and I will be required to pass a North Carolina state-approved nurse aide I training program and the North Carolina state-approved nurse aide I competency examination. I give my permission to any state registry to disclose all information requested in this application to the North Carolina Division of Health Service Regulation, Health Care Personnel Education and Credentialing Section.

First Name (print): _________________________________________________________________________________

Middle Name (print): _______________________________________________________________________________

Last Name (print): _________________________________________________________________________________

Signature: _________________________________________________ Date: ________________________________

REMINDER:

You Must Submit All Pages of the Application (Pages 1 through 6), Your Social Security Card, and a Current Government-Issued Identification with Photograph and Signature for Review and Approval.

DHSR/HCPEC-4515 (Revised February 2021)

Page 6 of 6

Download South Carolina Nurse Aide PDF Form

Form Data

Fact Name	Description
Authority	North Carolina Department of Health and Human Services Division of Health Service Regulation Health Care Personnel Education and Credentialing Section
Contact Information	Phone: 919-855-3969, Fax Number: 919-733-9764
Application Review Time	DHSR has 10 business days from date of receipt to review the application.
Eligibility Requirements	Applicants must meet five criteria, including being listed as active and in good standing on another state's registry and having no pending or substantiated findings of abuse or neglect.
Submission Instructions	Complete all pages using black or blue ink and submit by mail or fax. Incomplete applications will not be processed. Do not submit more than one application unless instructed by DHSR.
Reciprocity Eligibility	Eligibility includes having worked as a nurse aide for at least 8 hours in the past two years or passing a state-approved competency exam if not employed as a nurse aide.
Identification Requirements	Applicants must have a social security card and an unexpired government-issued ID with a photograph and signature. Names must match across documents.
Governing Law	Consistent with Rule 10A NCAC 13O .0301 and requirements of 42 CFR 483.152 or 42 CFR 483.154 for nurse aide training and competency evaluation programs.

Instructions on Utilizing South Carolina Nurse Aide

Filling out the South Carolina Nurse Aide form is a crucial step for those seeking to be listed on the North Carolina Nurse Aide I Registry through reciprocity. The process requires careful attention to detail and the submission of all requested information accurately. To ensure a smooth and successful application process, the steps below are designed to guide applicants through each section of the form, underscoring the importance of completeness and accuracy. Once the form is filled out and all necessary documentation is prepared, the applicant is ready to submit their application for review.

Read Part 1 of the form to determine if you meet the eligibility requirements for listing on the North Carolina Nurse Aide I Registry. Pay close attention to the five criteria outlined.
Use only black or blue ink to complete pages 1 through 6 of the application. This ensures the information is readable when faxed.
On the Personal Information page, answer all questions clearly. Write your legal name, including any hyphens and suffixes, and provide prior names if applicable. Fill in your gender, Social Security Number, email address, telephone number, and date of birth.
Answer questions regarding military service, marital status to a military member or veteran, and provide your mailing address, including street/PO Box, city, state, zip code, apt. #, and county.
In Part 3, indicate whether you have completed a state-approved Nurse Aide I Training Program and passed a state-approved Nurse Aide I Competency Examination.
Complete the table in Part 4 with information on any other states where you have an active or expired nurse aide I registry listing. Include the state name, original issue date, expiration date, registry certification or abbreviation, listing registration number, and whether the registry is current/active. Attach additional sheets if listed on more than three state nurse aide registries or if there are any pending issues on any state registry.
In Part 5, select the employment type(s) relevant to your experience over the past 2 years. Do not include private duty nurse aide employment if that was your role.
Provide detailed employment history for the past 2 years in Part 6, not including private duty roles. Include employer information, dates of employment, and whether the employer was a staffing agency. Specify any states where you worked for the staffing agency.
Confirm whether you received monetary compensation as a nurse aide and completed at least 8 hours of nursing or nursing-related tasks under a Registered Nurse's supervision in the last 2 years. Provide the Registered Nurse's first and last name.
Review all information for accuracy and completeness. Attach any required supportive documentation, ensuring it is clearly readable and correctly identifies you.
Submit the completed application and documentation by mail or fax to the address or fax number provided, ensuring not to send more than one application unless instructed by DHSR.

Following these steps carefully will help ensure that your application is complete and can be processed without unnecessary delays. Remember, completeness and accuracy are key to a successful application.

Obtain Answers on South Carolina Nurse Aide

Who is eligible for reciprocity on the North Carolina Nurse Aide I Registry?

Individuals are eligible for reciprocity if they meet five criteria: they must be active and in good standing on another state's nurse aide registry, have no pending or substantiated findings of misconduct, have at least eight hours of employment performing nurse or nurse-related tasks under the supervision of a Registered Nurse within the past two years, possess a social security card and an unexpired government-issued identification with matching names, and have completed a state-approved nurse aide training and competency evaluation program.

What documents are required for the Nurse Aide I Registry Reciprocity Application?

Required documentation includes the completed application form, proof of being listed as active and in good standing on another state's nurse aide registry, identification documents, and, if applicable, documentation verifying any name changes. Applicants may also need to provide a letter from a current employer if working as a nurse aide.

How should the application form be submitted?

The completed application, along with all required supporting documents, should be submitted using either black or blue ink. It can be returned by mail to the specified address or by fax to the given number. Only one application should be submitted unless otherwise instructed.

What if my name has changed?

If the name on your social security card and government-issued identification does not match the name listed on the nurse aide registry of the state(s) of reciprocity or between the two IDs, you must provide official documentation verifying the name change, such as a marriage license or divorce decree.

Can I apply if I have only worked as a private duty nurse aide?

No, private duty nurse aide employment does not meet the eligibility requirements for reciprocity. Eligible employment must involve nursing or nurse-related tasks delegated and supervised by a Registered Nurse.

What if I have not been employed as a nurse aide in the past two years?

Individuals who have not been employed as a nurse aide in the past two years can still be eligible for reciprocity if they successfully passed a state-approved nurse aide I competency examination and were listed on the Nurse Aide I Registry in the state(s) of reciprocity during that time.

Is employment through a staffing agency considered eligible employment?

Yes, employment through a staffing agency is considered eligible if the nurse aide performed tasks delegated and supervised by a Registered Nurse within the past two years. However, specific information about the states where the applicant worked for the staffing agency in the past two years must be provided.

What information is required in the employment history section?

The employment history section requires details of the facilities, agencies, or employers where nursing or nursing-related tasks were performed under the supervision of a Registered Nurse in the past two years. This includes the name of the employer, address, dates of employment, and whether the employer was a staffing agency. If the applicant did not work as a nurse aide, this section can be left blank.

What happens if I submit more than one application?

Applicants are advised not to submit more than one application unless instructed by the Department of Health Service Regulation. Submitting multiple applications without being instructed to do so may delay the processing of your application.

Can I apply for reciprocity if I am listed on more than three state nurse aide registries?

Yes, applicants listed on more than three state nurse aide registries can apply for reciprocity. However, they must attach a separate sheet of paper providing the registry information for the additional states not listed in the main table of the application form.

Common mistakes

Filling out the South Carolina Nurse Aide form requires careful attention to detail. Here is a list of eight common mistakes people make, which could delay or impact the success of their application:

Using Incorrect Ink: Applicants often overlook the instruction to use only black or blue ink, leading to submissions that cannot be faxed successfully.
Incomplete Applications: Not submitting all required pages (1 through 6) and necessary supportive documentation is a common oversight that results in processing delays.
Mismatched Names: Failing to ensure the name on the social security card and government-issued ID exactly matches the name listed on the nurse aide registry in the state(s) of reciprocity prevents successful verification.
Lack of Employment Verification: Some applicants forget to validate their employment as a nurse aide for at least eight hours within the past two years, which is crucial for those without recent employment in a state-approved role.
Not Including Required Proof: For active listings, applicants sometimes neglect to include documentation verifying active and good standing status from their state’s nurse aide registry, dated within 30 days before application submission.
Ignoring Eligibility Criteria: Applicants mistakenly think private duty nurse aide employment qualifies them for reciprocity; however, it does not meet the necessary eligibility requirements.
Overlooking Name Change Documents: When names do not match across documents, applicants often omit the required documentation for verifying name changes (e.g., marriage license, divorce decree).
Incorrect or Missing Employment History: Some fail to provide detailed employment history where nursing or nursing-related tasks were performed under the supervision of a Registered Nurse, or they leave this section blank if not currently employed, ignoring the need to demonstrate their competency and experience.

Apart from these points, it's equally important to carefully review each part of the application for accuracy and completeness before submission. Avoiding these common mistakes can save time and ensure a smoother application process.

Documents used along the form

When professionals in the health care sector, particularly those seeking to be nurse aides, engage with forms like the South Carolina Nurse Aide form, they're engaging with just one element of a broader spectrum of necessary documentation. These forms and documents are vital for the clear communication and validation of the credentials, personal information, and professional experience of an individual. They ensure that standards are met and maintained within the healthcare environment, which is crucial for patient safety and care quality.

Employment Verification Letter: This document, often required from a current or previous employer, confirms the nurse aide's employment duration, job duties, and performance. It serves as proof of the professional experience listed on the application.
State-Approved Training Program Certificate: A certificate from a state-approved training program demonstrates completion of the requisite coursework and practical training for nurse aides.
Competency Evaluation Results: This document verifies that the candidate has successfully passed the competency evaluation, which assesses the nurse aide's knowledge and skills.
Copy of Social Security Card: A social security card is requested to verify the applicant's identity and eligibility for employment in the United States.
Government-Issued Photo Identification: Along with a social security card, a government-issued photo ID verifies the applicant's identity and ensures that the name matches across all documents.
Name Change Documentation: If applicable, documents such as a marriage certificate, divorce decree, or court order are required to verify any name change from the name listed on the applicant's identification or social security card.
Criminal Background Check: A comprehensive criminal background check is often required to ensure the applicant has no history of behaviors that would disqualify them from working closely with vulnerable populations.
Medical Clearance and Immunization Records: These records ensure that the candidate is in good health and has received immunizations required for healthcare workers, protecting both the worker and patients from transmissible diseases.

The compilation of these documents, alongside the South Carolina Nurse Aide form, creates a robust profile of the candidate’s eligibility and qualifications for the position. It's a meticulous process, but a necessary one, reinforcing the inherent responsibility and ensuring the highest standards of care within the healthcare field.

Similar forms

Medical License Application: Similar to the South Carolina Nurse Aide form, a Medical License Application requires detailed personal information, proof of educational credentials, and a clean record of professional conduct. Both need verification of eligibility criteria before processing.
Employment Verification Form: This form, like the Nurse Aide form, mandates the disclosure of recent work history, including employers’ details and duties performed, to verify professional experience. It primarily focuses on ensuring the applicant has relevant and recent experience in their field.
Professional Certification Renewal Form: Renewal forms for professional certifications often require holders to demonstrate ongoing eligibility, similar to how the Nurse Aide form asks for evidence of continuous professional development and criminal record checks.
State-Issued ID Application: Just as the Nurse Aide form requires, applications for a state-issued ID demand personal information verification, including social security number, a government-issued photo ID, and additional documents to prove identity and residency.
Background Check Authorization Form: This type of form also collects personal information and requires consent to perform background checks, paralleling the Nurse Aide form's requirement to have no pending or substantiated findings of misconduct.
College Admission Application: Similar in its request for personal history, educational background, and eligibility criteria, this application, like the Nurse Aide form, asks for detailed personal and educational information to assess eligibility for admission.
Job Application Forms: These forms often require detailed work history, references, and certifications or licenses relevant to the position, akin to the Nurse Aide form's requirements for validating professional experience and credentials.
Professional Registration Forms for Other Healthcare Roles: These might include applications for registering as a pharmacist, physical therapist, or other healthcare workers. They similarly require proof of education, professional standing, and legal eligibility to practice in the healthcare field.

Dos and Don'ts

Filling out the South Carolina Nurse Aide form is a crucial step for those seeking to work as nurse aides in South Carolina. It's important to approach this process carefully to ensure accuracy and compliance with requirements. Below are do's and don'ts to consider when completing the form:

Do's:

Thoroughly review all eligibility requirements before starting the application to ensure you meet the criteria for being listed on the North Carolina Nurse Aide I Registry.
Complete all sections of the application (pages 1 through 6) and any required supporting documentation. Leaving parts incomplete can delay the process.
Use black or blue ink only when filling out the form to ensure that all information is legible and can be read by fax machines, if applicable.
Ensure names match across your social security card, government-issued identification, and registry in the state(s) of reciprocity. Discrepancies can cause delays.
Include any required documentation that verifies your eligibility, such as proof of active and in good standing listings on another state's nurse aide registry.
Check for accuracy and legibility in your personal information, including your name, social security number, and contact details, to avoid issues in communication.
Submit the application as instructed, whether by mail or fax, to the provided address or fax number, ensuring timely delivery within application deadlines.

Don'ts:

Don't submit more than one application unless specifically instructed by the Division of Health Service Regulation.
Don't use nicknames or incomplete names. Always provide your full legal name as it appears on your identification documents and social security card.
Don't overlook the requirement for having worked at least eight hours performing nursing or nursing-related tasks in the past two years. This is a key eligibility criterion.
Don't ignore the employment type section. Private duty nurse aide employment, for instance, does not meet the eligibility requirements for reciprocity.
Don't forget to include documentation for any name changes, such as a marriage license or divorce decree, if applicable.
Don't leave out information about employment history where you performed nursing or nursing-related tasks under the supervision of a Registered Nurse if this applies to you.
Don't submit the application without double-checking all information for completeness and accuracy to prevent any processing delays.

Misconceptions

When discussing the Nurse Aide I Registry Reciprocity Application for North Carolina, it's crucial to dispel several common misconceptions. These misunderstandings can create confusion for applicants, potentially leading to delays or issues in the application process. Let's address some of these myths.

Misconception #1: One can use any ink color to fill out the application. The instructions specify that only black or blue ink is acceptable. This is because other colors may not be readable via fax, a detail that applicants might overlook, leading to the rejection of their application.
Misconception #2: Temporary listings on another state's registry are sufficient for reciprocity. The application clearly states that a temporary listing will not be accepted. Applicants must be listed as active and in good standing on another state registry to qualify.
Misconception #3: All types of nurse aide employment qualify for the required experience. Specifically, private duty nurse aide employment does not meet the eligibility requirements for reciprocity. This distinction is vital for applicants relying on their work experience to qualify.
Misconception #4: Pending findings of abuse or misconduct are not a significant barrier. In fact, having no pending or substantiated findings is a prerequisite. Any such findings recorded on any state registry disqualify the applicant.
Misconception #5: Military experience is not relevant to the application. The form asks if the applicant has performed nursing or nursing-related tasks as part of their military occupational specialty, indicating that certain military experiences are indeed relevant.
Misconception #6: Submitting multiple applications can speed up the process. The form instructs not to submit more than one application unless directed by DHSR, suggesting that multiple submissions could complicate or delay the review instead.
Misconception #7: I.D.s with differing names do not pose an issue. The names on the applicant's social security card and government-issued identification must match, and also match the name listed on the nurse aide registry in the state(s) of reciprocity. If they do not, documentation verifying any name changes must be submitted.
Misconception #8: Any state-approved nurse aide training is sufficient. The training and competency evaluation program must meet the requirements of 42 CFR 483.152 or a state-approved competency evaluation that meets the requirements of 42 CFR 483.154. Not all programs may meet these specific standards.
Misconception #9: The application does not need to be legible or complete. The instructions emphasize that the application will not be processed if it is incomplete. Thus, ensuring that all sections are filled out legibly and entirely is crucial for a successful application process.

Dispelling these misconceptions ensures a smoother application process for those seeking Nurse Aide I Registry reciprocity in North Carolina, guiding applicants towards successful registration.

Key takeaways

Applicants seeking reciprocity for the North Carolina Nurse Aide I Registry must adhere to a set of critical requirements and guidelines to ensure their applications are processed efficiently. Here are seven key takeaways about filling out and using the South Carolina Nurse Aide form:

Only those applicants who are actively listed in good standing on another state's nurse aide registry and have no pending or substantiated findings of abuse, neglect, or misappropriation of resident or patient property are eligible for reciprocity.
Applicants must have worked for at least eight hours performing nursing or nursing-related tasks under the supervision of a Registered Nurse in the past two years or have passed a state-approved nurse aide competency examination within the same timeframe if they were not employed as a nurse aide.
It is required that applicants have a social security card and an unexpired government-issued photo identification, with names that match across all documents. In cases where names do not match, appropriate documentation verifying the name change must be submitted.
Completion of a state-approved nurse aide training and competency evaluation program that meets federal requirements is necessary for eligibility.
Applicants must complete all sections of the application form using black or blue ink and ensure the application is legible and free of omissions. Incomplete applications will not be processed.
Submission of the application can be done via mail or fax. Applicants are advised against submitting more than one application unless specifically instructed by DHSR.
Employment in private duty nurse aide positions does not qualify for eligibility towards reciprocity criteria. The employment history section should include information on employment where nursing or nursing-related tasks were performed under the supervision of a Registered Nurse within the last two years.

Note: The Department of Health Service Regulation (DHSR) has a review period of 10 business days from the date of receipt to review the application. It is crucial for applicants to ensure that all documentation and information provided are accurate and complete to avoid any delays in the reciprocity process.

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