CA CDPH 612 2011 free printable template
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X Director of Nursing/Designee Signature CDPH 612 Rev 01/11 INSTRUCTIONS The information on this form must be legible accurate and complete. CDPH LICENSE 5. FACILITY NAME 6. FACILITY ADDRESS 7. ADMINISTRATOR 8. DIRECTOR OF NURSING/DESIGNEE 9. ESTIMATED NURSING HOURS and NHPPD BEGINNING SCHEDULED PATIENT TOTAL CENSUS NURSING HOURS NHPPD 10. DAILY CENSUS CHANGES Add or subtract from the beginning census each event during the designated census period Method a SHIFT 1 or Method b Beginning...
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How to fill out CA CDPH 612
How to fill out CA CDPH 612
01
Obtain the CA CDPH 612 form from the California Department of Public Health website.
02
Fill out the identification section with your name, address, and contact information.
03
Provide detailed information about the facility or organization you represent.
04
Complete the section regarding the type of services being provided.
05
Include information on any relevant health and safety certifications.
06
Review all entered information for accuracy before submission.
07
Sign and date the application form.
08
Submit the completed CA CDPH 612 form to the appropriate CDPH office either by mail or electronically.
Who needs CA CDPH 612?
01
The CA CDPH 612 form is needed by facilities or organizations that provide certain health-related services in California, including but not limited to healthcare providers, community health organizations, and public health programs.
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People Also Ask about
What are the requirements for Dhppd?
The 3.5 DHPPD staffing requirement, of which 2.4 hours per patient day must be performed by CNAs, is a minimum requirement for SNFs. SNFs shall employ and schedule additional staff and anticipate individual patient needs for the activities of each shift, to ensure patients receive nursing care based on their needs.
How do you calculate nursing hours?
General Formula: Establish the Ward Category and associated hours for that category from Schedule B – NHPPD Guiding Principles. Ward Category NHPPD x number of ward beds occupied = nursing hours.
What is Dhppd?
California Department of Public Health. Census and Direct Care Service Hours Per Patient Day (DHPPD)
What is a 612 form?
I-612, Application for Waiver of the Foreign Residence Requirement (under Section 212(e) of the Immigration and Nationality Act, as Amended)
How do you determine HPPD?
HPPD is a metric commonly used in healthcare facilities to measure the productivity and efficiency of their operations. It stands for Nursing Hours Per Patient Day, and it is calculated by dividing the total number of nursing hours worked by the total number of patients in the facility.
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What is CA CDPH 612?
CA CDPH 612 is a form used by healthcare providers in California to report communicable diseases, outbreaks, and other related health information to the California Department of Public Health.
Who is required to file CA CDPH 612?
Healthcare providers, including physicians, laboratories, and other entities that diagnose or treat reportable conditions, are required to file CA CDPH 612.
How to fill out CA CDPH 612?
To fill out CA CDPH 612, complete all relevant sections accurately, including patient information, diagnosis, and details about the disease or condition being reported, and submit it according to the provided instructions.
What is the purpose of CA CDPH 612?
The purpose of CA CDPH 612 is to facilitate the reporting of communicable diseases to help monitor public health and respond to potential outbreaks.
What information must be reported on CA CDPH 612?
Information that must be reported on CA CDPH 612 includes patient demographics, clinical information, laboratory results, and any epidemiological data related to the disease.
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