TNA to CNA Verification Form - State of Louisiana

TNA to CNA Verification Form

Name of NH/LTCF Facility Address Facility Phone Administrator Name

State ID

Facility Contact Name Administrator email address

The following are requirements for TNA to transition to CNA: 1) Minimum of 8 hours temporary nurse aide course or equivalent 2) Minimum of 16 hours skills/competency verification 3) Minimum of 60 hours worked as a Temporary Nurse Aide

Once hours have been met, TNA is eligible to take Nurse Aide Competency Evaluation administered by Prometric.

Candidates: Provide the name (last name, first name) of all Temporary Nurse Aides that have met requirements for TNA to CNA Transition.

Submission of this form serves as attestation that the individuals listed above are eligible to take the Nurse Aide Competency Evaluation because they meet the TNA to CNA Transition

requirements, as specified by the Louisiana Department of Health, Health Standards Section.

Signature of NFA or designee (electronic signature is acceptable)

Date

Complete this form electronically and in its entirety and email to LDH Nurse Aide Registry. Verification of receipt will be provided.

See TNA to CNA Transition for additional information.

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