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Ohio Department of Health Division of Quality Assurance Registered/Licensed Nurse Staffing Waiver Application Facility Name Provider Number Street Address City Zip County Telephone including Area Code FAX including Area Code E-mail Maximum Licensed Capacity of this Facility Does this facility operate a Nurse Aide Training and Competency Evaluation Program NATCEP Yes No Name of Administrator LNHA Number Name of Director of Nursing DON License Numb...
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How to fill out registeredlicensed nurse staffing waiver

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How to fill out Registered/Licensed Nurse Staffing Waiver Application

01
Obtain the Registered/Licensed Nurse Staffing Waiver Application form from the relevant health department or agency.
02
Fill out the applicant's information, including name, address, and contact details.
03
Provide details of the facility requesting the waiver, including the type of facility and its license number.
04
Describe the specific staffing shortages that necessitate the waiver.
05
Include any supporting documentation, such as recruitment efforts and reasons for the staffing shortage.
06
Sign and date the application form to certify that the information is accurate.
07
Submit the completed application to the designated department, either by mail or electronically, depending on requirements.
08
Follow up with the agency for any additional information or clarification that may be needed.

Who needs Registered/Licensed Nurse Staffing Waiver Application?

01
Healthcare facilities facing shortages of Registered or Licensed Nurses may require the waiver to maintain operations.
02
Facilities that are unable to meet state nurse-to-patient ratios due to an acute staffing crisis.
03
New healthcare facilities in the process of becoming fully staffed may seek this waiver as they build their nursing staff.
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People Also Ask about

Call the FCSR at 1-866-422-6872.
(E) Good Cause Waiver means a finding that it is reasonable to believe that the restrictions imposed by section 660.317, RSMo, on the employment of an applicant may be waived after an examination of the applicant's prior work history and other relevant factors is conducted and demonstrates that such applicant does not
How to Check on the Status of a Good Cause Waiver Calling the FCSR toll-free access line at 1-866-422-6872 and asking to have a GCW verified. The employer will need to provide the individual's full name and social security number in order to obtain verification of the waiver. Checking: Has An Application Been Submitted?
In other words, facilities must meet the minimum 3.48 total nurse staffing, 0.55 RN, and 2.45 NA HPRD standards regardless of the individual facility's resident case-mix, as they are the minimum standard of staffing.

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The Registered/Licensed Nurse Staffing Waiver Application is a formal request submitted by healthcare facilities seeking permission to operate with fewer registered or licensed nurses than typically required, due to unique circumstances impacting staffing.
Healthcare facilities, such as hospitals and nursing homes, that are unable to meet the required nurse-to-patient ratios due to factors like recruitment challenges or emergency situations are required to file this application.
To fill out the Registered/Licensed Nurse Staffing Waiver Application, applicants must provide detailed information about their facility, current staffing levels, the circumstances necessitating the waiver, and any measures taken to address staffing deficiencies.
The purpose of the Registered/Licensed Nurse Staffing Waiver Application is to allow healthcare facilities flexibility in staffing while ensuring patient safety and quality of care are not compromised during periods of staffing shortages.
The application must report information including the facility’s current nurse staffing levels, the number of patient admissions, specific reasons for the waiver request, and any attempts made to hire additional staff.
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