Nurse Aide Registry Applications and Forms - Oklahoma State Department of Health

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

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Renewal Application for Certified Nurse Aides and Certified Medication Aides

Recertification Application, ODH Form 717 (70K)

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Other Nurse Aide Applications

Reciprocity Application, ODH Form 735 (123K)

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

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NURSE AIDE TRAINING PROGRAM APPLICATIONS

Please contact Kathryn Waller, Health Facilities Surveyor, for Nurse Aide Training and Competency Evaluation Program applications at: (405) 271-9444 ext 50151 or toll free 800-695-2157 or e-mail kathrynew@health.ok.gov.

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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
Phone (405) 271-4085 or toll free 800-695-2157
E-Mail nar@health.ok.gov

Abuse Registry Activity Director and Social Services Director Courses Certified Nurse Aide Career Ladder Training Nurse Aide Registry Applications and Forms Feeding Assistants Nurse Aide Training Program Resources Office of Inspector General List of Excluded Individuals/Entities Uniform Employment Application for Nurse Aide Staff	OSDH Home > Protective Health > Health Resources Development Service > Nurse Aide and Nontechnical Services Worker Registry > Nurse Aide Registry Applications and Forms
	email \| print 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 Guardian of Person Making Application for a License, Permit or Certification, ODH Form 266 (32K) [Back to top of page.] Renewal Application for Certified Nurse Aides and Certified Medication Aides Recertification Application, ODH Form 717 (70K) [Back to top of page.] Other Nurse Aide Applications Reciprocity Application, ODH Form 735 (123K) Duplicate or Amended Nurse Aide Card, ODH Form 738 (75K) [Back to top of page.] NURSE AIDE TRAINING PROGRAM APPLICATIONS Please contact Kathryn Waller, Health Facilities Surveyor, for Nurse Aide Training and Competency Evaluation Program applications at: (405) 271-9444 ext 50151 or toll free 800-695-2157 or e-mail kathrynew@health.ok.gov. [Back to top of page.] 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) [Back to top of page.] Contact Information Nurse Aide Registry 1000 N.E. 10th Street, Room 1111 Oklahoma City, OK 73117 Phone (405) 271-4085 or toll free 800-695-2157 E-Mail nar@health.ok.gov	Q: May I fax or e-mail my application to the Nurse Aide Registry? A: The Registry requests that all applications be mailed to the address on the top of the form, or dropped off on the 1st floor of the Oklahoma State Department of Health in Oklahoma City.

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