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2025 Medication Assistant, Certified (MAC) Annual Report
Healthcare Organization Information
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1.
Name of Healthcare Organization
(Required.)
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2.
Alabama Department of Public Health (ADPH) Number (if applicable)
(Required.)
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3.
Name of person completing this report:
(Required.)
4.
License number of person completing this report (if applicable)
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5.
Name of Chief Nursing Officer, Director of Nursing, or Designated RN Supervisor
(Required.)
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6.
Nursing License Number:
(Required.)
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7.
Employer or CNO/DON contact information
(Required.)
Telephone number
Email address
