Get the free 11-09 Provider-directed single activity Application CORRECTED.docx - lsna

Louisiana State Nurses Association 5713 Superior Drive, Suite A6 Baton Rouge, Louisiana 70816 2252010993 and 2252010971(fax) Luna.org Application for ProviderDirected CNE Activity A. General Directions:

How to fill out 11-09 provider-directed single activity

How to fill out 11-09 provider-directed single activity

1. Step 1: Begin by gathering all necessary information and documentation required to fill out the form.
2. Step 2: Enter the date and basic details of the provider-directed single activity in the designated spaces.
3. Step 3: Specify the objectives, goals, and expected outcomes of the activity.
4. Step 4: Provide detailed instructions on how the activity should be conducted and any specific requirements.
5. Step 5: Indicate the time duration and schedule for the activity.
6. Step 6: Include any resources or materials needed to successfully complete the activity.
7. Step 7: Describe the evaluation process and how the success of the activity will be measured.
8. Step 8: Sign and date the form, and ensure all necessary signatures from involved parties are obtained.
9. Step 9: Submit the filled-out form to the appropriate authority or department as instructed.

Who needs 11-09 provider-directed single activity?

1. Organizations or institutions that provide directed single activities to their clients or participants.
2. Educational institutions or trainers who design and implement provider-directed single activities.
3. Government agencies or departments that oversee the delivery of provider-directed single activities.
4. Individuals or professionals involved in the planning and execution of provider-directed single activities.

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What is 11-09 provider-directed single activity?

11-09 provider-directed single activity is a reportable activity completed by a provider as directed by a specific party.

Who is required to file 11-09 provider-directed single activity?

The provider who carried out the directed activity is required to file the 11-09 provider-directed single activity report.

How to fill out 11-09 provider-directed single activity?

To fill out the 11-09 provider-directed single activity, the provider must include relevant details about the directed activity, such as date, location, purpose, and any outcomes.

What is the purpose of 11-09 provider-directed single activity?

The purpose of 11-09 provider-directed single activity is to document and report activities completed by a provider as directed by another party.

What information must be reported on 11-09 provider-directed single activity?

The information reported on 11-09 provider-directed single activity may include details about the directed activity, parties involved, date, duration, location, and any outcomes or results.