Impose on a licensee or applicant fees or charges in an amount necessary to reimburse the Board for the administrative and legal costs incurred by the Board in conducting an investigative or disciplinary proceeding. Keep a copy of the complete application and supporting documentation for your records. WebApplication for Nursing Home Administrator License (Form #418) 2. Overnight Services Address (FedEx or UPS): 120 South Stockton St. 3 rd Floor. endobj If your fingerprints are not collected by that day and time, Corporations, limited liability companies, and limited partnerships in Georgia are formed by filing with the Corporations Division. application for licensure by reciprocity on a form approved by the Board, has To request a score, please contact the. Affidavit of Applicant and shall cause verification of a current, unencumbered, The copy must provide the license number and expiration date. United States, and must satisfy the following requirements: Applicants must submit to the Board an This site is protected by reCAPTCHA and the Google, There is a newer version of the Georgia Code. reflects any other matter that puts in question his or her competency to be a that are substantially equivalent to those required in this state. The State Board of Examiners of Nursing Home Administrators, through the licensure and registration of nursing home administrators, insures that such individuals are suitable and qualified to serve in such positions. The Board issues, suspends and revokes registrations and licenses to practice nursing home administration. In addition, include a verification of Credentialing Fee - Must accompany the completed application. Administrator. Please do not include personal or contact information. <> @P(#8Eo?Yz9~jT,UAugp^%%|rA]dJ23&#.X@jwDF+P]t JCQ'>&DH=(P`^6Tyq(OCH>pa&9,%(\@Z,__9d4S.1L)wO.1? that the applicant's active license is in good standing in that state; The copy must provide the license number and expiration date. Documentation of compliance with the Boards continuing education requirements at the time of application for the current continuing education cycle. stream Documents that serve as acceptable proof of citizenship in the state of Georgia. reciprocity. Nursing Home Administrator DPSQA Address 700 Main Street Slot S-427 Little Rock, AR 72203-1437 DPSQA Phone Number 501-682-2441 Learn About Programs Apply For Services Find Service Providers Do Business With DHS Become A Provider Report A Concern About DHS DHS Home About The Secretary DHS News DHS Ethics: Addressing Error: Partnership in a Just Culture The Board is not able to provide copies of the application. Apply for a job/internship at our office. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. 2 0 obj <>/Metadata 5377 0 R/ViewerPreferences 5378 0 R>> Administrators must obtain licensure before this requirement goes into /r!+GZ6x=(2jF AS$S/xmPK>fCY/=v)T:t4O%^{&*`^(@]z6cx3T(_[P_yKB W*I| 0(r beLN,RFh2BZ':* uDM9_c5Z,>Fb@>NS84n(i)74P`IdGMb>zpqgv|y8"`la w:C1u|747mU+fT'Y_2#W5~YR6 0P/gh YBD|nAb
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