Certified Medication Developmental Disabilities

STATE OF LOUISIANA

OFFICE FOR CITIZENS WITH DEVELOPMENTAL DISABILITIES

CERTIFIED MEDICATION ADMINISTRATION

“RECERTIFICATION REQUESTS”

TO:

OCDD CMA COORDINATOR

FROM: CMA INSTRUCTOR:

Address

Phone Number

RE: “RECERTIFICATION” EFFECTIVE DATE:

CMA NAME

SS #

EMPLOYER

EMPLOYER ADDRESS

The above named CMA has met the requirements for recertification. Please issue a certificate.

Documentation of successful completion of 9 hours of ongoing training of medication administration. Two of the 9 hours were regarding agency policy and procedures on medication administration.

Successfully passed with proficiency the 25 skills on the practical checklist on an annual basis or at both the point of hire and at the point of recertification if the CMA was hired during the certification period.

CMA INSTRUCTOR SIGNATURE

DATE

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