Nurse Aide Registry Applications and Forms

    Legal Resident Affidavit Forms
    Recertification Application for Nurse Aides
    Other Nurse Aide Applications
    Nurse Aide Training Program Applications
    Notification Forms
    Contact Information

NOTE: Applications on this page have been converted to PDF files. You will need the Adobe™ Acrobat ™ Reader to view the files.  A short-cut is provided on the left in the blue column. 

  IMPORTANT REQUIREMENTS FOR RENEWAL!  The Oklahoma Taxpayer and Citizen Protection Act of 2007 requires anyone seeking a license, permit, or certificate to complete an affidavit of legal residence. One of the legal resident affidavit forms, linked below, must be completed and submitted to the Nurse Aide Registry with each nurse aide certification and/or recertification application. The relevant portion of the law may be found at Title 21 O.S. Section 1550.42.

Legal Resident Affidavit Forms

    Affidavit of Lawful Presence by Person Making Application for a License, Permit or Certification, ODH Form 301 (29K) 

    Affidavit of Lawful Presence by Person Making Application for a License, Permit or Certification - Spanish, ODH Form 301A (31K)

    Affidavit of Lawful Presence by Guardian of Person Making Application for a License, Permit or Certification, ODH Form 266 (32K)

    Affidavit of Lawful Presence by Guardian of Person Making Application for a License, Permit or Certification - Spanish, ODH Form 266A (33K)

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Recertification Application for Certified Nurse Aides and Certified Medication Aides

    Recertification Application, ODH Form 717 (70K)

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Other Nurse Aide Applications

    Duplicate or Amended Nurse Aide Card, ODH Form 738 (75K)

    Reciprocity Application, ODH Form 735 (123K)
 
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NURSE AIDE TRAINING PROGRAM APPLICATIONS

Nurse Aide Training And Competency Evaluation Program Applications

    Adult Day Care Aide, ODH Form 743F (26K)

        Addendum to ODH Form 743F (48K)

    Certified Medication Aide, ODH Form 743C (25K)

    Combination Home Care and Long Term Care Aide, ODH Form 743G  (39K)

    Developmentally Disabled Direct Care Aide, ODH Form 743D (27K)

        Addendum to ODH Form 743D (36K)

    Home Care Aide, ODH Form 743A (30K)

    Long Term Care Aide, ODH Form 743B (33K)

        Addendum to ODH Form 743B (48K)

    Residential Care Aide, ODH Form 743E (27K)
 
Applications for Advanced Nurse Aide Training And Competency Evaluation Programs

    Certified Medication Aide - Diabetes Care, ODH Form 504 (508K)

    Certified Medication Aide - NG/Gastrostomy/Oral Metered Dose Inhaler/Nebulizer, ODH Form 506 (785K)

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Notification Forms

    Notification of Instructor Changes, ODH Form 742 (10K)

    Notification of Nurse Aide Abuse, Neglect, Mistreatment or Misappropriation of Property, ODH Form 718 (9K) 

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Contact Information
Nurse Aide Registry
1000 N.E. 10th Street, Room 1111
Oklahoma City, OK  73117-1299
Phone (405) 271-4085
Fax     (405) 271-1130
E-Mail  nar@health.ok.gov