First name: Employee type: Middle name: Last name: Social security #: Date of birth:   **Note: Expiration for all CNAs is exactly two years from Certification Date.

Responsibility of Medicare and Medicaid Enrolled Providers To Avoid Hiring Excluded Individuals

Every provider is held responsible on the federal and state level for ensuring that their employees have not been excluded by either the federal Office of Inspector General or State Medicaid Program Integrity. To determine if an employee or prospective employee is excluded, check the Louisiana Department of Health and Hospitals Adverse Actions website at the link listed below:

**Note: The website should be checked upon hire and monthly thereafter.

If you have questions regarding exclusions, call 225-342-1427.

Information & Instructions for Nurse Aide (CNA) Retesting

 State of Louisiana
 CNA - DSW Registry
 5647 Superior Drive
 Baton Rouge, LA 70816
 Phone: 225-295-8575
 Fax: 225-295-8578
*If you know the SSN, enter the SSN only. CNA/DSW Lookup. Enter search criteria below: Date: 09/03/2015 15246