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Emedny 520101 2026
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- Click ‘Get Form’ to open the emedny 520101 in the editor.
- Begin by selecting the appropriate box for your provider type: either Licensed Home Care Services Agency (LHCSA) or Independently Enrolled Nurse. Fill in your agency name, NYS license number, and Medicaid Provider Identification Number.
- For LHCSA providers, certify that the nurses providing services are trained and experienced in caring for medically fragile pediatric patients. Ensure you maintain documentation for inspection.
- If you are an independently enrolled nurse, provide your name, NYS license number, and specify your training details along with completion dates. Include any relevant skills such as tracheostomy care or home infusion.
- Sign and date the form at the bottom to confirm your certification of training and experience before submitting it through eMedNY.
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