Certified
Medication Technician (CMT) INITIAL Application Checklist
To assure that INITIAL CMT applications are processed, the following may assist you in performing a final check of the
INITIAL CMT applications prior to sending the applications to the Board.
- Do you have the appropriate application? Remember an
INITIAL CMT application is completed only ONCE. If the applicant has been certified as a CMT in the past at any time – a renewal application with the CMT’s certification number must be completed instead of an
initial application
- Have all data fields on the INITIAL application been completed? (see
INITIAL application instructions that accompany the INITIAL application – be sure to only check one of these selections on question 18).
- Has the facility check or money order been attached to the INITIAL application? Personal checks are not accepted and will be returned with your application. The facility check may be for one specific individual or multiple individuals. If the facility check is to pay for multiple individuals there must be a transmittal documenting the name of each individual covered by the facility check. There must be separate checks for those individuals who are making
application for initial certification and a separate check for those individuals applying for
renewal of the certification.
- Has a passport photo, full face 2x2 inches, been attached to the
INITIAL application?
- Has the MT applicant signed the
INITIAL application?
- Has the RN, CM/DN signed the
INITIAL application?
- Has the class list been completed?
(all data fields filled in including the specific name of the RN,
CM/DN approved to teach the training program)
- Is the completed class list attached to the
INITIAL application?
- For the applicant who has already been certified as a CMT and who is repeating the 20-hour training program because their certificate has expired, this applicant needs to complete a CMT
Paper RENEWAL form with his/her CMT certification number. In addition a separate class list must accompany the renewal indicating the applicant is renewing the expired CMT certification by completing the 20 hour CMT Training Program again, (see item three for issues related to facility checks).
- For any MT applicant who has answered “Yes” to any discipline question(s) – This application is also
to be sent separately with a class list.
*** INITIAL APPLICATIONS WILL BE RETURNED TO THE RN, CM/DN WHO TAUGHT THE TRAINING PROGRAM SHOULD THE APPLICATION REQUIREMENTS NOT BE MET.
|
DATA YOU WILL NEED TO SUBMIT TO THE BOARD IN ORDER FOR THE BOARD TO INVESTIGATE A DELAY IN CERTIFICATION: |
- Name of applicant
- Social Security number
- Name of RN, CM/DN who taught to 20 Hour MT Training Program
- Date the MT Training Program was completed
- Date material was mailed to the Board
|
|
HOW TO CONTACT THE BOARD
- e-mail is preferred
|
| Kia Alexander |
alexanderk@dhmh.state.md.us
|
410-585-1918 |
| Jaray Jarvis |
jjarvis@dhmh.state.md.us
|
410-585-2051 |
|
If further assistance is needed please contact:
|
Ethel
Stanley Administrator, CNA
Program |
estanley@dhmh.state.md.us
|
410-585-1934 |
| CNA Training Program fax number |
|
410-764-8042 |
{# pagefooter(); #}
|