CA CDPH 612 2018 free printable template
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Daily Census Changes Add or subtract from the beginning census each event during the designated census period Method a Shift 1 or Method b patient day 8 hours after beginning of Beginning Census Admissions Discharges Transfers Deaths Other Total Direct Care of Census Period Total CNA Direct at End of Census Period CDPH 612 6/18 11. State of California-Health and Human Services California Department of Public Health Census and Direct Care Service Hours Per Patient Day DHPPD 1. Patient Date...
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How to fill out CA CDPH 612
01
Gather necessary information: Collect details about the facility, including address and contact information.
02
Identify the services provided: Specify the type of healthcare services or programs offered by the facility.
03
Complete the facility information section: Fill in the name of the facility, type of ownership, and license number if applicable.
04
Provide staffing information: List all personnel involved in the services, including their qualifications and roles.
05
Fill out the patient population section: Indicate the demographic details of the patients being served, including age range and specific needs.
06
Detail policies and procedures: Document the facility's policies relevant to patient care and operations.
07
Sign and date the form: Ensure the form is signed by an authorized individual and submitted by the deadline.
Who needs CA CDPH 612?
01
Any healthcare facility operating in California that provides specific services and requires certification or licensing from the California Department of Public Health (CDPH).
02
Organizations implementing Medi-Cal or other state-funded healthcare programs may also need to submit the CA CDPH 612.
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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 the California Department of Public Health for reporting cases of communicable diseases.
Who is required to file CA CDPH 612?
Healthcare providers, laboratories, and certain institutions are required to file CA CDPH 612 when they identify cases of reportable communicable diseases in California.
How to fill out CA CDPH 612?
To fill out CA CDPH 612, you should complete the form with accurate patient information, details of the disease, and submit it to the California Department of Public Health as per the provided guidelines.
What is the purpose of CA CDPH 612?
The purpose of CA CDPH 612 is to collect data on communicable diseases to monitor public health, guide interventions, and prevent outbreaks.
What information must be reported on CA CDPH 612?
The information that must be reported on CA CDPH 612 includes patient demographics, disease specifics, date of diagnosis, and any relevant clinical information.
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