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Fill Out Your Utah Dopl Ap Form

The Utah DOPL AP form serves as a comprehensive guide and application for individuals seeking certification as a Medication Aide or a temporary Medication Aide in the state of Utah. Managed by the Division of Occupational and Professional Licensing, the form outlines the essential steps, required documentation, and appropriate fees to ensure that applicants submit a complete application. Failure to adhere to these guidelines can result in processing delays or denial of the certification, emphasizing the critical importance of thoroughness and compliance with the process.

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Outline

For individuals aspiring to become certified medication aides in Utah, understanding the nuances of the Utah Division of Occupational and Professional Licensing (DOPL) Medication Aide Certified application process is essential. This comprehensive procedure demands meticulous attention to detail, as applicants are required to submit a complete application alongside a series of supporting documents and a non-refundable fee. The objective is to streamline the licensure process, ensuring that applicants can promptly and efficiently obtain their certification. However, incomplete submissions or failure to provide accurate information can delay this process or lead to application denial. Additionally, the form serves as a bridge to complying with specific legal and professional standards, including undergoing a criminal background check, completing approved educational training, and passing the mandatory Medication Aide Certified Examination or obtaining temporary certification if eligible. Further, it's crucial for applicants to maintain their address of record with DOPL up to date, to ensure they receive all pertinent communications. Moreover, applicants are also entrusted with the responsibility of familiarizing themselves with Utah's laws and rules relevant to their practice, a critical step for both initial certification and ongoing practice. The procedure, while straightforward, encapsulates the state's commitment to upholding the highest standards in healthcare service provision, ensuring that only qualified individuals are certified to perform their roles as medication aides.

Preview - Utah Dopl Ap Form

STATE OF UTAH

DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING

MEDICATION AIDE CERTIFIED

MEDICATION AIDE CERTIFIED TEMPORARY

APPLICATION INSTRUCTIONS AND INFORMATION:

General Statement: The Utah Division of Occupational and Professional Licensing (DOPL) desires to provide courteous and timely service to all applicants for licensure. To facilitate the application process, submit a complete application form including all applicable supporting documents and fees. Failure to submit a complete application and supply all necessary information will delay processing and may result in denial. The fees are for processing your application and will not be refunded. Please read

all instructions carefully.

Address of Record: The address provided on this application WILL BE YOUR ADDRESS OF RECORD. All correspondence from DOPL will be sent to that address. You are responsible to directly notify DOPL of any change to your address of record. Do not rely on a forwarding order as state mail is not forwarded.

Social Security Number: A social security number is classified as a private record under the Utah Government Records Access and Management Act. It is used by DOPL as an individual identifier. It is also used for child support enforcement pursuant to Subsection 78-32-17(3) and is mandatory pursuant to Subsection 58-1-301(1), Utah Code Ann., which implements 42 U.S.C. 666(a) (13). If a Social Security Number is not provided, the application is incomplete and may be denied.

APPLICATION INSTRUCTIONS:

Mandatory Attachment Checklist (Applications with incomplete attachments will not be considered and may be denied.)

Submit a complete Division of Occupational Licensing (DOPL) Medication Aide Certified application to the DOPL

address listed below. If you are applying for a temporary certification, you will need to complete the full application. Submit a $90.00 Non-Refundable Application Fee, made payable to “DOPL.” This fee includes a $50.00 application fee

and a $20.00 surcharge for a BCI fingerprint file search, and a $20.00 surcharge for a FBI fingerprint file search.

Submit two applicant fingerprint cards (Form FD-258: white with blue lines) to be used by DOPL for a search through the files of the Bureau of Criminal Identification (BCI) and the Federal Bureau of Investigation (FBI). If you

bring your completed application to DOPL’s office at 160 E 300 S, Main Lobby, Salt Lake City, your fingerprints can be electronically scanned using DOPL’s Identix equipment.

Submit documentation of having completed an approved Medication Aide Certified (MAC) training program. Request

that the training program submit documentation of completion directly to DOPL. Failure to submit official documentation of completion will result in denial of your application as incomplete.

Submit documentation of current certification in good standing as a Certified Nursing Assistant with the Utah Nursing

Assistant Registry.

Submit documentation of a high school diploma or its equivalent.

Submit documentation of a minimum of 2,000 hours of experience as a certified nurse aide in a long-term care facility

within the two years prior to application. Documentation may include W-2 tax forms or a letter from the administrator of a long-term care facility.

Submit two letters of recommendation from a long-term care facility administrator and one licensed nurse familiar with

your work practices as a certified nurse aide.

Submit documentation of successful completion of the MACE Certification Examination

Submit the “Temporary Certification Form”. Please note that the temporary certification will expire if you do not sit for the first available examination or if you fail the examination. Once you have taken the MACE Certification Examination, submit documentation of successful completion to DOPL.

DOPL-AP Rev 2013-09/05

*Important Additional Important Information:

1.Application Processing: Processing time for an application, where the fingerprints have been electronically scanned by DOPL and there are no issues that need to be resolved, is approximately 7 to 21 business days if the application is complete. If the application is incomplete, the processing time will increase.

2.Laws and Rules: You are required to understand Utah laws and rules pertaining to your practice. The following laws and rules are available on the Internet at www.dopl.utah.gov.

Division of Occupational & Professional Licensing Act, 58-1 (Jul 01 2012)

General Rules of the Division of Occupational & Professional Licensing, R156-1 (November 26, 2012)

Nurse Practice Act, 58-31b (Jan 01 2013

Nurse Practice Act Rules, R156-31b (July 08 2010)

3.Education Requirement: You must complete an approved Medication Aide Certified program. Completion of an approved program is documented by submitting an official document from the training program includes the date of completion.

4.Examination Requirement: The required examination will be NCSBN’s Medication Aide Certified Examination (MACE). However, this examination will not be available until February 1, 2014. If you are submitting an application for a temporary certification, please contact the Division after February 1, 2014 for information regarding the MACE examination.

5.Temporary Certification: Temporary Certification may be issued to a person who meets all licensure requirements except the passing of the MACE examination. The temporary certification will be issued for a period of twelve (12) months. Please note: The temporary certification will automatically expire upon release of official examination results if the applicant fails the examination or if the applicant does not take the first available examination.

6.Certification Renewal: All medication aide certified certification expire March 31 of each odd-numbered year. Each licensee is responsible to renew the license PRIOR to the expiration date shown on the current certification. Approximately two months prior to the expiration date shown on the license, renewal information is disseminated to each licensee’s address of record, as provided to DOPL. Under Utah’s renewal system, all licenses in each profession expire as a group on the same day every two years. Therefore, the length of a licensee’s first renewal cycle depends on how far into the current renewal cycle initial licensure was obtained. Each renewal cycle thereafter is for a full two years. Additionally, the fee paid with this application for licensure is an application-processing fee only.

7.Updating Address Information: It is your responsibility to maintain a current address with DOPL. If your address is incorrect, you will not receive correspondence from DOPL. Address changes can be made online at www.dopl.utah.gov.

Please note that the Division of Occupational and Professional Licensing, section 58-1-301.7(1) Change of information reads:

(a)An applicant, licensee, or certificate holder shall send the division a signed statement, in a form required by the division, notifying within 10 business days of a change in mailing address.

(c)In addition to providing a mailing address, an applicant, licensee, or certificate holder may provide to the division, in a form required by the division, an email address and may designate email as the preferred method of receiving notifications from the division.

7.Name Change: If you have been licensed or certified by DOPL under any other name, please submit documentation of your name change (i.e. copy of a marriage license or divorce decree).

8.Fingerprint Information: All applicants are required to undergo a criminal background check and fingerprint search through the files of the bureau of Criminal Identification (BCI) and the Federal Bureau of Investigation (FBI). To expedite the licensure process, you can obtain electronic fingerprinting at DOPL’s office at 160 E. 300 S., Salt Lake City, 8:00 a.m. to 4:30 p.m., Monday through Friday, except holidays. The cost for having fingerprints electronically scanned by DOPL is covered in the $40 non-refundable surcharge fee. Applicants that arrive late in the day without leaving sufficient time to be processed will be turned away. A current government issued picture ID is required and would include one of the following: a driver’s license issued by Washington D.C., a state of the United States of America or an identification card issued by the state of Utah.

DOPL-AP Rev 2013-09/05

If you are unable to obtain electronic fingerprints at DOPL’s office, you must include two (2) blue fingerprint cards (Form FD-258) with your application for each individual associated with the application as defined above. To have your fingerprints rolled onto the blue fingerprint cards, you must go to BCI, a local police station or an agency authorized by the FBI to roll fingerprints. If you downloaded the application from the Internet, you may obtain fingerprint cards the Bureau of Criminal Identification (BCI), your local police station or authorized agency. Fingerprint cards that are not complete and/or properly rolled will be rejected, delaying the licensure process. Due to the high number of inked fingerprint cards that are rejected and the amount of time it takes state and federal government agencies to process these cards, applicants are encouraged at the time of application to have their fingerprints electronically scanned at DOPL or at the Bureau of Criminal Identification.

Bureau of Criminal Identification (BCI) Information:

Check with BCI for pricing of their services

Walk-ins only; no appointments taken

Fingerprinting and Photo Services are available from 8:00 a.m. – 5:00 p.m., Monday - Friday except holidays

Government-issued picture ID required (driver’s license, state ID, passport, etc.)

Address: 3888 W. 5400 S., Taylorsville, UT 84118 (1/2 block west of Bangerter Highway, behind McDonalds)

Website: www.bci.utah.gov. Telephone number: (801) 965-4569

Review of your FBI Record: If you wish to challenge the accuracy of the information in your FBI record, you should contact the agency that contributed the information in question. You may also direct the challenge to the FBI, Criminal Justice Information Services (CJIS) Division, Attn. SCU, Mod. D-2, 1000 Custer Hollow Road, Clarksburg, WV 26306. The FBI will forward the challenge to the respective agency.

11.Acceptable Forms of Payment: Licensure fees can be paid by check or money order, made payable to “DOPL.” Cash and debit/credit cards (American Express, MasterCard, and Visa) are also accepted in person at DOPL’s main office. Credit card information is not accepted over the telephone.

12. Mail Complete Application to:By U.S. Mail Division of Occupational & Professional Licensing

P.O. Box 146741

Salt Lake City, Utah 84114-6741

By Delivery or Express Mail

Division of Occupational & Professional Licensing

160East 300 South, 1st Floor Lobby Salt Lake City, Utah 84111

Telephone Numbers:

(801) 530-6628

(866) 275-3675 – Toll-free in Utah

DOPL-AP Rev 2013-09/05

BLANK PAGE

(FOR TWO-SIDED PRINTING)

DOPL-AP Rev 2013-09/05

State of Utah

DIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING

160 East 300 South, P.O. Box 146741

Salt Lake City, Utah 84114-6741

Telephone (801) 530-6628

www.dopl.utah.gov

MEDICATION AIDE CERTIFIED MEDICATION AIDE CERTIFIED TEMPORARY

***Please list your full legal name as it appears on your driver’s license, Social Security Card, etc.***

Last Name:			First Name:		Middle Name:

Social Security Number:	-	-		Maiden Name:

I certify under penalty of perjury that:

I am a citizen of the United States and I have a valid US Driver License or US State ID.

License/State ID Number:

State:

I am a citizen of the United States currently living outside the United States and do not have a valid US Drivers License or US State ID. Please attach a legible copy of your valid passport or other documentation to verify you are a legal citizen of the United States.

I am a non-citizen of the United States, who is lawfully present in the United States and I have a valid US Drivers License or US State ID.

License/State ID Number:State:

I am a non-citizen of the United States, who is lawfully present in the United States and I do not have a valid US Drivers License or US State ID. Please attach a legible copy of your current and valid government issued document showing evidence of authorization to work in the United States.

I am a foreign national not physically present in the United States.

Mailing Address:

City:				State:	ZIP:

Male	Date of Birth:	Phone #:	E-Mail:
Female	Date of Birth:	Phone #:	E-Mail:
Female

DO NOT WRITE IN THIS SECTION - FOR DIVISION USE ONLY
License/Certificate/Exam approval Number:
Date License/Certificate/Exam approval - Approved: ___/___/____
Approved By:
Date License/Certificate/Exam approval Denied: ___/___/____
Denied By:
Reason for Denial/Other Comments:

DOPL-AP Rev 2013-09/05

List all licenses, registrations, or certifications issued by any state which you now hold or have ever held in any profession. (Use

additional sheets if necessary.)

Profession:	Issuing State:

License/Certification Number:	License/Certification Status:	Issue Date:

Profession:	Issuing State:
License/Certification Number:	License/Certification Status:	Issue Date:

I do not hold registrations, or certifications issued by any jurisdiction.

Approved Medication Aide Certified Training Program:

(Course must be at least 60 clock hours of classroom learning and 40 clock hours of clinical practice.)

Name of Training Program:

Address of Program:

City:		State:	Zip:

Dates Attended:	From:	To:

High School Education Requirement:

	Name of School:
	City:	State:		Zip:
	Date of Graduation:
OR:	Equivalent Education:		Date Earned:

Medication Aide Certified Examination Requirement:

Date Taken:

Number:

Expiration:

AFFIDAVIT and RELEASE AUTHORIZATION

I am the applicant described and identified in this application for licensure, certification, or registration in the State of Utah.

I am qualified in all respects for the license, certificate, or registration for which I am applying in this application.

To the best of my knowledge, the information contained in the application and its supporting document(s) is free of fraud, misrepresentation, or omission of material fact.

To the best of my knowledge, the information contained in the application and its supporting document(s) is truthful, correct, and complete; and, discloses all material facts regarding the applicant and associated individuals necessary to properly evaluate the applicant’s qualifications for licensure.

I will ensure that any information subsequently submitted to the Division of Occupational and Professional Licensing in conjunction with this application or its supporting documents meet the same standard as set forth above.

I understand that it is unlawful and punishable as a class A misdemeanor to apply for or obtain a license or to otherwise deal with the Division of Occupational and Professional Licensing or a licensing board through the use of fraud, forgery, or intentional deception, misrepresentation, misstatement, or omission.

I understand that this application will be classified as a public record and will be available for inspection by the public, except with regard to the release of information which is classified as controlled, private, or protected under the Government Records Access and Management Act or restricted by other law.

I authorize all persons, institutions, organizations, schools, governmental agencies, employers, references, or any others not specifically included in the preceding characterization, which are set forth directly or by reference in this application, to release to the Division of Occupational and Professional Licensing, State of Utah, any files, records, or information of any type reasonably required for the Division of Occupational and Professional Licensing to properly evaluate my qualifications for examination approval/licensure/certification/registration by the State of Utah.

Signature of Responsible Party:

Date of Signature: ____/____/____

Printed Name of Responsible Party:

COMPLIANCE WITH UTAH LAWS AND RULES

I understand that it my continuing responsibility to read, understand, and apply the requirements contained in all statutes and rules pertaining to the occupation or profession for which I am applying, and that failure to do so may result in civil, administrative, or criminal sanctions.

Name: ____________________________________ Signature: ____________________________________ Date: __________

DOPL-AP Rev 2013-09/05

			MEDICATION AIDE CERTIFIED QUALIFYING QUESTIONNAIRE
			Read thoroughly, and answer the questions. Do not leave any question blank.
		(Note: If you have formally expunged a criminal record you do not need to disclose that criminal history.)

Yes	No	1.	Have you ever applied for or received a license, certificate, permit, or registration to practice in a regulated
Yes	No		profession under any name other than the name listed on this application?


Yes	No	2.	Have you ever been denied the right to sit for a licensure examination?

Yes	No	3.	Have you ever had a license, certificate, permit, or registration to practice a regulated profession denied,
Yes	No		conditioned, curtailed, limited, restricted, suspended, revoked, reprimanded, or disciplined in any way?

		4.	Have you ever been permitted to resign or surrender a license, certificate, permit, or registration to practice in a
Yes	No		regulated profession while under investigation or while action was pending by any health care profession licensing
			agency, hospital or other health care facility, or criminal or administrative jurisdiction?
Yes	No	5.	Are you currently under investigation or is any disciplinary action pending against you now by any licensing
Yes	No		agency or governmental agency?
			agency or governmental agency?
Yes	No	6.	Have you ever had hospital or other health care facility privileges denied, conditioned, curtailed, limited, restricted,
Yes	No		suspended, or revoked in any way?
			suspended, or revoked in any way?
		7.	Have you ever been permitted to resign or surrender hospital or other health care facility privileges, while under
Yes	No		investigation or while action was pending by any licensing agency, hospital or other health care facility, or criminal
			or administrative jurisdiction?
Yes	No	8.	Is any action related to your conduct or patient care pending at any hospital or health care facility?
Yes	No

Yes	No	9.	Have you ever had rights to participate in Medicaid, Medicare, or any other state or federal health care payment
Yes	No		reimbursement program denied, conditioned, curtailed, limited, restricted, suspended, or revoked in any way?

		10.	Have you ever been permitted to resign from Medicaid, Medicare, or any other state or federal health care payment
Yes	No		reimbursement program while under investigation or while action was pending by any licensing agency, hospital,
			or other health care facility, or criminal or administrative jurisdiction?
Yes	No	11.	Is any action pending against you now by Medicaid, Medicare, or any other state or federal health care payment
Yes	No		reimbursement program?
			reimbursement program?
		12.	Have you ever had a federal or state registration to sell, possess, prescribe, dispense, or administer controlled
Yes	No		substances denied, conditioned, curtailed, limited, restricted, suspended or revoked in any way by either the federal
			Drug Enforcement Administration or any state drug enforcement agency?
		13.	Have you ever been permitted to surrender a registration to sell, possess, prescribe, dispense, or administer
Yes	No		controlled substances while under investigation or while action was pending by any health care profession
			licensing agency, hospital or other health care facility, or criminal or administrative jurisdiction?
Yes	No	14.	Is any action now pending against you by either the Federal Drug Enforcement Administration or any state drug
Yes	No		enforcement agency?
			enforcement agency?
Yes	No	15.	Have you been named as a defendant in a malpractice suit?

Yes	No	16.	Have you ever had office monitoring, practice curtailments, individual surcharge assessments based upon specific
Yes	No		claims history, or other limitations, restrictions, or conditions imposed by any malpractice carrier?

Yes	No	17.	Have you ever had any malpractice insurance coverage denied, conditioned, curtailed, limited, suspended, or
Yes	No		revoked in any way?
			revoked in any way?
		18.	If you are licensed in the occupation/profession for which you are applying, would you pose a direct threat to
Yes	No		yourself, to your patients or clients, or to the public health, safety, or welfare because of any circumstance or
			condition?
Yes	No	19.	Have you ever been declared by any court of competent jurisdiction incompetent by reason of mental defect or
Yes	No		disease and not restored?
			disease and not restored?

Yes	No	20.	Have you ever been terminated from a position because of drug use or abuse?
		21.	Are you currently using or have you recently (within 90 days) used any drugs (including recreational drugs)
Yes	No		without a valid prescription, the possession or distribution of which is unlawful under the Utah Controlled
			Substances Act or other applicable state or federal law?
		22.	Have you ever used any drugs without a valid prescription, the possession or distribution of which is unlawful
Yes	No		under the Utah Controlled Substances Act or other applicable state or federal law, for which he has not
Yes	No		successfully completed or is not now participating in a supervised drug rehabilitation program, or for which he has

			not otherwise been successfully rehabilitated?
Yes	No	23.	Have you ever had a documented case in which he was involved as the abuser in any incident of verbal, physical,
Yes	No		mental, or sexual abuse?
			mental, or sexual abuse?
Yes	No	24.	Do you currently have any criminal action pending?
Yes	No	25.	Have you ever pled guilty to, no contest to, or been convicted of a felony in any jurisdiction?
DOPL-AP Rev 2013-09/05				7

Yes	No	26.	Have you ever been incarcerated for any reason in any federal, state or county correctional facility or in any
Yes	No		correctional facility in any other jurisdiction or on probation/parole in any jurisdiction?

		27.	Have you ever pled guilty to, no contest to, entered into a plea in abeyance or been convicted of a misdemeanor in
Yes	No		any jurisdiction? Motor vehicle offenses such as driving while impaired or intoxicated must be disclosed but
			minor traffic offenses such as parking or speeding violations need not be listed.
Yes	No	28.	Have you been allowed to plea guilty or no contest to any criminal charge that was later dismissed (i.e. plea-in-
Yes	No		abeyance or deferred sentence)?
			abeyance or deferred sentence)?

If you answered “yes” to questions 24, 25, 26, 27 or 28 above, you must submit a complete narrative of the circumstances that occurred for EACH and EVERY conviction, plea in abeyance, and/or deferred sentence. You must also attach copies of all applicable police report(s), court record(s), and probation/parole officer report(s).

If you are unable to obtain any of the records required above, you must submit documentation on official letterhead from the police department and/or court indicating that the information is no longer available.

If you have formally expunged a criminal record as evidenced by a court order signed by a judge, you do not need to disclose that criminal history. Expungement orders must be sent to the Bureau of Criminal Identification and the FBI to enable the expungement to be completed and the criminal history eliminated from the records.

If you answered “yes” to any of the above questions, enclose with this application complete information with respect to all circumstances and the final result, if such has been reached.

A “yes” answer does not necessarily mean you will not be granted a license; however, DOPL may request additional documentation if the information submitted is insufficient.

DOPL-AP Rev 2013-09/05

Utah Division of Occupational and Professional Licensing 160 East 300 South, P.O. Box 146741

Salt Lake City, Utah 84114-6741 FAX: (801) 530-6511

MEDICATION AIDE CERTIFIED

TEMPORARY CERTIFICATION

REQUEST FORM

TO BE COMPLETED BY APPLICANT:

Name:			Telephone:

Address:
City:	State:	Zip:		Email:

Date Taking MACE Examination:

Employing Facility:			Telephone:
Address:
City:	State:	Zip:		Email:

Date Employment Begins:

I hereby certify that I will not practice as a medication aide certified until I have been granted a temporary license. Once the temporary license has been issued, I will only practice under direct supervision of a license nurse as defined in the Nurse Practice Act Rule R156-31b-102(41).


Signature of Applicant:	Date:

TO BE COMPLETED BY SUPERVISING NURSE:

Name:

Address:				Telephone:
City:	State:		Zip:		Email:
Position or Title:		License Number:

I hereby certify that I am a licensed nurse in good standing and I will supervise the practice of the above named Medication Aide Certified. I understand that I must provide direct supervision, and be on the same site as the applicant. The Nurse Practice Act Rule subsection R156-31b-102 reads:

(41) "Supervision", as used in this rule, means the provision of guidance and review by a licensed nurse for the accomplishment of a nursing task or activity, including the provision for the initial direction of the task, periodic inspection of the actual act of accomplishing the task or activity, and evaluation of the outcome.

Signature of Supervisor:	Date:

DOPL-AP Rev 2013-09/05

Download PDF Form

File Specifications

Fact	Detail
1. Application Purpose	The Utah DOPL Medication Aide Certified application facilitates licensure for individuals seeking to become certified medication aides in Utah.
2. Complete Application Requirement	Applicants must submit a complete application, including all required documents and fees, to avoid delays or denial.
3. Address of Record	The address provided in the application becomes the applicant's official address of record for all DOPL correspondence.
4. Social Security Number Requirement	A social security number is mandatory for application processing, as dictated by Utah Code Ann. Subsection 58-1-301(1).
5. Governing Laws and Rules	Applicants must familiarize themselves with specific laws and rules, including the Division of Occupational & Professional Licensing Act and the Nurse Practice Act.
6. Education and Examination Requirements	Successful completion of an approved Medication Aide Certified program and passing the MACE examination are required for certification.
7. Certification Renewal and Address Update	All certifications expire on March 31 of each odd-numbered year. Holders must renew their certifications before expiration and update their address with DOPL as needed.

How to Write Utah Dopl Ap

When trying to secure a Medication Aide Certified position or a temporary certification in the State of Utah, the journey begins with successfully completing and submitting the Utah DOPL AP form. This critical step requires attention to detail and a careful gathering of the necessary documentation. Understandably, the process might seem daunting initially, but with a clear direction and understanding of what is required, applicants can navigate it with confidence. Every document, from the training completion evidence to fingerprint cards, plays a distinctive role in showcasing your eligibility and readiness for the role you are aspiring to. Ensuring that each part of the application is accurately filled out and that all supporting documents are in order will streamline the process, bringing you one step closer to your goal.

To guide you through this crucial process, here are the steps needed to fill out the form:

Begin by clearly printing your full legal name as it appears on your official documents such as your driver's license and Social Security card.
Fill out your Social Security Number in the space provided, being careful to ensure accuracy.
If applicable, include your Maiden Name.
Under the certification section, mark the appropriate box that correctly describes your citizenship or residency status and provide your driver's license or state ID number and state. If you do not have a valid U.S. Driver's License or State ID, or if you are not currently living in the United States, you will need to attach alternative documentation as directed.
Enter your mailing address, including city, state, and zip code to ensure that all correspondence from DOPL reaches you without delay.
Provide your date of birth, contact number, and email address to complete your contact details. This information is crucial for communication regarding your application’s progress. Specify your gender by marking either Male or Female, as per the provided options.
Attach the Mandatory Attachment Checklist items, paying close attention to each required document. Ensure that your application fee is made payable to “DOPL” and includes all the necessary surcharges for fingerprinting.
If electronic fingerprints are not feasible, include two completed fingerprint cards with your application. Remember, improperly completed cards can delay your application.
Verification of completing an approved Medication Aide Certified training program and evidence of your current certification as a Certified Nursing Assistant in good standing are mandatory. Ensure these documents are sent directly from the issuing organizations to DOPL.
Document your education with evidence of a high school diploma or its equivalent.
Proof of 2,000 hours of experience as a certified nurse aide in a long-term care facility within the two years prior to your application is needed. It can be verified through W-2 tax forms or an official letter from a long-term care facility administrator.
Include two letters of recommendation—one from a long-term care facility administrator and the other from a licensed nurse familiar with your work.
If applicable, submit documentation of successful completion of the MACE Certification Examination or the “Temporary Certification Form” if you are applying for temporary certification.
After sitting for the MACE Certification Examination, ensure to forward results to DOPL as soon as you receive them.

After the completion of these steps, mail your application to the Division of Occupational & Professional Licensing at the address provided, selecting the postal service that best suits your needs. By carefully following these instructions, you will have successfully completed your initial step toward becoming a Medication Aide Certified professional or obtaining your temporary certification in Utah.

Frequently Asked Questions

What documents and information are required to complete the Medication Aide Certified application for Utah?

To ensure a smooth application process, applicants must submit several key items, including the completed DOPL Medication Aide Certified application form, a non-refundable application fee of $90, two FD-258 fingerprint cards for background checks, proof of completion of an approved MAC training program, documentation of current certification as a Certified Nursing Assistant in Utah, proof of a high school diploma or equivalent, evidence of 2,000 hours of experience as a CNA in a long-term care facility within the last two years, and two letters of recommendation from appropriate professionals.

How can I change the address on my application or license record with the DOPL?

Maintaining an up-to-date address with DOPL is crucial for receiving important correspondence. You can update your address information online at www.dopl.utah.gov. Remember, you are responsible for notifying DOPL of any address changes to ensure you do not miss critical information or renewal notices.

What is the Application Processing time for a Medication Aide Certified application?

The processing time for applications where fingerprints have been electronically scanned by DOPL can range from approximately 7 to 21 business days, provided the application is complete and there are no issues. Incomplete applications or those requiring additional information may take longer to process.

Can the application fee be refunded?

No, the application fee is non-refundable. These fees cover the cost of processing your application, regardless of the outcome.

What if I have been certified or licensed under a different name?

If you have been certified or licensed under a different name, you must provide documentation of your name change, such as a marriage license or a divorce decree, to ensure your records are correct and up to date.

What are the temporary certification conditions for Medication Aide Certified applicants?

Temporary Certification may be granted to individuals who meet all licensure requirements except passing the MACE examination. This certification is valid for 12 months. Note that it will automatically expire if the examination is not taken at the first available opportunity or if the examination is failed.

How is a Social Security Number used in the application process?

Your Social Security Number is used as an individual identifier and for child support enforcement purposes, as mandated by law. Failing to provide it will render your application incomplete and potentially lead to denial.

What should I do if my FBI or BCI background check has incorrect information?

If you believe there is incorrect information on your FBI or BCI record, you should first contact the agency that contributed the information. If necessary, you can challenge the accuracy directly with the FBI, which will forward the challenge to the appropriate agency to ensure your record is correct.

How often do I need to renew my Medication Aide Certified certification, and how?

All Medication Aide Certified certifications expire on March 31 of each odd-numbered year. You must renew your certification before the expiration date indicated on your current certificate. Renewal information will be sent to your address of record approximately two months before your certification expires. It is crucial to ensure your contact information is current to receive these notices.

Common mistakes

Filling out the Utah DOPL application form for Medication Aide Certification requires close attention to detail. Unfortunately, some common mistakes can delay the approval process or even result in denial. By being aware of these pitfalls, applicants can enhance their chances of a smooth and swift application process.

Not submitting a complete application: It’s crucial to submit all required sections of the application form. Missing information can lead to delays or denial. Ensure that every section is filled out accurately, providing complete supporting documents and the correct fees.
Failing to provide a valid Social Security Number: A Social Security Number is mandatory for application completeness. Without it, the application is considered incomplete and may be denied, as the SSN is used for identification and Child Support Enforcement purposes.
Incorrect address of record: The address you provide becomes your official address of record. Any correspondence from DOPL, including your certification, will be sent to this address. If you move and fail to update your address directly with DOPL, you may miss crucial information or even your certification delivery.
Omitting mandatory attachments: Each application must be accompanied by specific documents, including proof of completed training, current certifications, and the non-refundable application fee. Forgotten attachments will result in your application not being considered.
Not providing accurate fingerprint cards: If choosing to submit physical fingerprint cards instead of electronic fingerprinting, ensuring the cards are filled out correctly and legibly is essential. Incorrect or illegible fingerprints can cause significant delays in the background check process, slowing down the entire licensure procedure.

Given the effort involved in preparing for a certification, it's disappointing to face setbacks due to avoidable errors. Applicants should take the time to review their application thoroughly before submission, double-checking that all information is correct and complete. This includes making sure that all required documents are attached and that fees are paid in full. Keeping a keen eye on these details can make the difference between a smooth application process and unnecessary delays.

Remember, the Utah DOPL is committed to providing timely service to applicants. However, this goal can only be achieved when applications are submitted correctly and completely. By avoiding these common mistakes, applicants pave the way for a smoother, more efficient certification process.

Documents used along the form

Applying for or renewing your Medication Aide Certification in Utah requires understanding not just the Utah DOPL AP form, but also several other forms and documents that may be necessary through this process. These assist in ensuring that all prerequisites are met and that your application or renewal is comprehensive, fostering a smoother procedure.

Certified Nursing Assistant (CNA) Certification Proof: In addition to the Utah DOPL AP form, you need to submit evidence of current certification as a Certified Nursing Assistant in good standing with the Utah Nursing Assistant Registry. This documentation verifies that you have the foundational medical knowledge and practical skills fundamental to progressing towards a Medication Aide Certified position.
Training Program Completion Documentation: Proof of having finished an approved Medication Aide Training Program is necessary. The training entity must send this directly to DOPL, confirming the specialized training you've completed. This documentation is crucial as it demonstrates that you have the educational background required specifically for medication aide duties.
FBI and BCI Background Check Forms: The necessity of including two fingerprint cards for the Bureau of Criminal Identification (BCI) and Federal Bureau of Investigation (FBI) background checks ensures that all candidates meet the strict safety and reliability standards expected of healthcare professionals. These background checks help protect vulnerable populations by ensuring candidates have no history that would make them unsuitable for such a sensitive role.
Proof of experience: Documentation showing a minimum of 2,000 hours of experience as a certified nurse aide in a long-term care facility within two years prior to application is required. W-2 tax forms or letters from the facility administrator can serve as proof. This experience requirement ensures that candidates possess the practical skills and situational awareness necessary to effectively and safely administer medications.

Understanding and compiling these documents alongside your Utah DOPL AP form is vital to navigating the certification process successfully. Each document plays a significant role in illustrating your qualifications and readiness to assume the responsibilities of a Medication Aide Certified professional. Efficiently managing these requirements will pave the way for a smoother certification process, allowing you to focus on your commitment to providing exceptional care.

Similar forms

The National Provider Identifier (NPI) application form issued by the Centers for Medicare & Medicaid Services (CMS) provides a solid comparison to the Utah DOPL AP form. Both forms serve healthcare-related personnel, but while the Utah DOPL AP specifically targets those seeking medication aide certification, the NPI application is broader, covering a range of healthcare providers who need an identifier for billing and identification purposes. Identical to the DOPL AP form, the NPI application requires detailed personal information, professional credentials, and compliance with federal regulations, underscoring the emphasis on security and professional verification in healthcare.

Another counterpart is the Nurse Licensure Compact (NLC) application form, which permits registered nurses and licensed practical/vocational nurses to practice in multiple states. Like the Utah DOPL AP form, the NLC application demands comprehensive information regarding education, prior licensure, and a background check to ensure public safety and professional integrity. Both documents are pivotal for advancing nursing careers by certifying qualifications while prioritizing patient safety across state lines.

The Certified Nursing Assistant (CNA) state certification application, required for CNAs to be listed in their state's registry, shares similarities with the Utah DOPL AP form. It requires verification of program completion, criminal background checks, and personal information to ensure applicants meet state-specific criteria. The emphasis on direct care experience, background screening, and educational attainment in both forms underscores the healthcare industry’s commitment to employing qualified individuals who meet rigorous standards.

State licensure applications for pharmacists present another parallel, focusing on credentialing professionals responsible for medication management, much like medication aides. These applications often necessitate education records, examination scores, and background checks, mirroring the DOPL AP's requirements for proving competency and ensuring that only qualified candidates are granted licensure to prevent medication errors and ensure public safety.

Finally, the application for licensure by endorsement for healthcare professionals seeking to practice in a new state closely aligns with the Utah DOPL AP form. This form typically requires detailed personal and professional information, proof of existing licensure in another state, and often a background check. The shared goal of ensuring that professionals maintain their qualifications across state lines while protecting public health reflects the interconnectedness of healthcare regulation and the standardized vetting process for practitioners nationwide.

Dos and Don'ts

When you're filling out the Utah DOPL AP form for Medication Aide Certified or Medication Aide Certified Temporary certification, carefully follow the instructions and pay attention to these tips to ensure a smooth application process:

Do:

Read all instructions carefully before you begin filling out the form to avoid any mistakes.
Provide a complete application, including all necessary supporting documents and fees, to prevent delays.
Use your current address as your address of record, understanding all correspondence from DOPL will be sent to this address.
Notify DOPL directly of any address changes as soon as possible to ensure you receive all correspondence.
Include your Social Security Number on the application, as it is mandatory for processing.
Pay the non-refundable application fee with the correct amount to avoid any processing delays.
Submit two fingerprints cards or have your fingerprints electronically scanned at the DOPL office if possible.
Provide documentation of completed training, current certification, education, and experience as required.
Update any change in name or information promptly to keep your records accurate.
Check your FBI record for accuracy if necessary, following the instructions provided if there are discrepancies.

Don't:

Leave sections incomplete. Incomplete applications may be denied or delayed.
Depend on mail forwarding. State mail is not forwarded; directly updating your address with DOPL is crucial.
Forget the application fee. Remember, the fee is non-refutable and necessary for your application to be processed.
Omit any required attachments. Double-check the mandatory attachment checklist before submission.
Delay in submitting your application. This can affect the processing time and potentially delay your certification.
Fail to check the requirements for the temporary certification if applicable.
Ignore the fingerprint requirement. Incomplete or improperly rolled fingerprints can delay processing.
Miss out on providing necessary documentation for training, experience, or examinations as required.
Ignore instructions for updating personal information such as name or address changes.
Use outdated information when filling out the form or submitting attachments.

Misconceptions

When navigating through the process of applying for a Medication Aide Certified or a Temporary Medication Aide Certified position in Utah, there are several misconceptions that can mislead applicants. Understanding these misconceptions is crucial to streamlining your application process and avoiding unnecessary hurdles.

Completing the application guarantees licensure. Although submitting a completed DOPL AP form is a critical step, it is essential to remember that approval is contingent upon meeting all specified requirements, including passing necessary checks and examinations.
Application fees are refundable. The fees paid at the time of application are for processing and are non-refundable, regardless of the application's outcome.
Electronic fingerprints are optional. While paper fingerprint cards are accepted, having fingerprints electronically scanned at DOPL's office when possible can expedite the licensure process considerably.
The address on the application doesn't matter. The address you provide becomes your address of record for all correspondence from DOPL, making it essential to ensure accuracy and update DOPL promptly with any changes.
Social Security Number (SSN) provision is optional. An SSN is required; failure to provide it renders the application incomplete and may lead to its denial.
Temporary certification is automatically extended. It is important to note that temporary certifications expire when official examination results are released or if the applicant fails to take the first available examination.
Licensure automatically renews. All medication aide certifications expire on March 31 of each odd-numbered year, and it is the licensee's responsibility to renew before this date without relying on reminders from DOPL.
Qualifications from any state are acceptable. While out-of-state qualifications may be relevant, applicants must still meet Utah-specific requirements and provide documentation of completion from approved programs within the state or recognized equivalents.
A high school diploma is optional. Submitting documentation of a high school diploma or its equivalent is a necessary prerequisite, underscoring the importance of providing comprehensive educational and professional records.

By understanding and addressing these misconceptions, applicants can improve the likelihood of a successful licensure application for the Medication Aide Certified role within Utah. It's imperative to approach this process with diligence, attention to detail, and adherence to the Utah Division of Occupational and Professional Licensing's requirements.

Key takeaways

Filling out and submitting the Utah DOPL Medication Aide Certified Application requires careful attention to detail and thoroughness to ensure a smooth process. Here are five key takeaways to assist applicants in successfully completing and using the form:

It's crucial to submit a completely filled application along with all required supporting documents and appropriate fees. A failure to do so results in processing delays and possible denial. The importance of a complete submission cannot be overstressed, as the fees are strictly for processing and are non-refundable.
The address you provide on this form becomes your official address of record. All communications from the Division of Occupational and Professional Licensing (DOPL) will be directed to this address. To avoid missing critical information, applicants must directly inform DOPL of any changes to their address of record. Relying on mail forwarding is not recommended since state mail is often not forwarded.
To facilitate a faster licensure process, applicants are encouraged to have their fingerprints electronically scanned at the DOPL’s office. This step is part of the mandatory background check for all applicants, which includes searches in the Bureau of Criminal Identification (BCI) and the Federal Bureau of Investigation (FBI) files. Submitting electronic fingerprints helps avoid the common delays associated with processing traditional ink fingerprint cards.
Applicants should be familiar with the relevant Utah laws and rules pertaining to their practice. This knowledge is not only essential for legal compliance but also a prerequisite for aspiring medication aides. The DOPL website provides access to the necessary legal resources, including the Division of Occupational & Professional Licensing Act, General Rules of the Division, and Nurse Practice Act Rules.
Obtaining a temporary certification is possible for individuals who meet all the requirements except for passing the MACE examination. This provision allows applicants to work within the field for a limited period, under specific conditions, until they can take and pass the examination. It's critical, however, to understand that the temporary certification has a strict expiration tied to examination results or the lapse of the first available examination opportunity without sitting for it.

By adhering to these key points, applicants can navigate the application process more effectively, ensuring all requirements are met and potentially expediting their path to certification. Remember, meticulousness in completing the application and understanding the associated rules and requirements are pivotal to success.

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