**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**
1.
Do you possess a current LPN license from the Maryland Board of Nursing or one of the states in the Multi-State Licensure Compact Current Membership?
Yes
No
2.
Please provide your license number and expiration date in the box below.
3.
Describe your experience working with patients with mental health and/or substance use disorders.
This experience should be included on your application. If you do not possess this type of experience, please put N/A in the text box.
4.
Describe your experience working with prior authorizations.
This experience should be included on your application. If you do not possess this type of experience, please put N/A in the text box.
Department of Budget and Management