Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part IX - Developmental Disabilities Services
Chapter 9 - Guidelines for Certification of Medication Attendant
Section IX-931 - Forms to be Used

1. Form CMA-1 is the profile sheet completed by the provider agency's administrator/representative to attest that all qualifications are met for the CMA applicant to attend the 60-hour medication administration course. This form is given to the CMA instructor.

2. Form CMA-2 is the exam request and initial certification request form completed by the CMA instructor and sent to either the regional office or developmental center coordinator to request the office schedule CMA applicant(s) for the OCDD CMA certification exam. Form CMA-1 must be attached to the CMA - 2 for each CMA applicant to be scheduled for the test. For those applicants that pass the test, the office will send the certificates to the CMA instructors.

3. Form CMA-3a. and 3b. are the re-certification requests completed by the CMA instructor acknowledging that all recertification requirements are met. The CMA instructor sends these forms to the central office coordinator for issuance of certificates.

4. Form CMA-4 is the decertification form completed by the CMA instructor identifying the reasons for decertifying the CMA and sent to the central office coordinator. Form CMA - 4 is also sent to the CMA along with a confidential letter. A copy of Form CMA - 4 must be maintained in provider agency records.

5. Form CMA-5 is the reciprocity request form the provider agency would complete for employees that furnish documentation of successful completion of an equivalent medication administration course from another state. This form is sent to the central office coordinator for review and determination.

6. Form CMA-6 is the form completed by the central office coordinator verifying a CMA is in good standing. This form is sent to provider agencies who employ a CMA in good standing certified by another agency. Form CMA - 6 must be keep on file in the provider records.