DHHS Form DHHS/DHSR/HCPR-4510 2015-2025 free printable template

2709 Mail Service Center Raleigh, NC 276992709 Division of Health Service RegulationHealth Care Personnel Education and Credentialing SectionPhone: 9198553970 Fax: 9197339764 N.C. Department of Health

How to fill out aide packet form

How to fill out DHHS Form DHHS/DHSR/HCPR-4510

1. Obtain the DHHS Form DHHS/DHSR/HCPR-4510 from the official DHHS website or your local office.
2. Start by filling out the personal identification section with your full name, address, and contact information.
3. Provide details about your healthcare facility, including its name, address, and type of services offered.
4. Indicate the purpose of the form, such as applying for a license or submitting a report.
5. Complete the section regarding the personnel involved, including names and qualifications.
6. Attach any required supporting documents, such as proof of insurance or compliance certificates.
7. Review the form for accuracy and completeness before signing and dating it.
8. Submit the completed form to the designated DHHS office either by mail or in person.

Who needs DHHS Form DHHS/DHSR/HCPR-4510?

1. Healthcare providers seeking to obtain a license or certification.
2. Facilities planning to offer healthcare services.
3. Any organization that is required to report specific information to the DHHS.

People Also Ask about dhhs dhsr hcpr 4510 application packet

How do I transfer my CNA license to North Carolina?

There are two ways for individuals who are certified in another state to become listed on the Nursing Aide Registry in North Carolina. You can take the Nurse Aide I training (or comparable) and pass the competency test or pass the state approved Nursing Aide I competency test.

How long does it take to get on the N.C. nurse aide Registry?

How long does it take to be listed on the registry after I complete the state-approved exam? Individuals are listed on the North Carolina Nurse Aide I Registry within 10 business days after successfully completing the North Carolina state-approved Nurse Aide I competency exam.

Can you renew your CNA license after it expires in North Carolina?

If your Nurse Aide II listing expired in the past 24 months, you are required to successfully complete the competency evaluation portion of the Nurse Aide II Program to be eligible for renewal.

Can I renew my CNA license online North Carolina?

There is no fee required to complete the online renewal form. If you do not meet the following eligibility requirements, then you are not eligible for renewal. Nurse aides working in a non-nursing home setting are responsible for making sure their job duties qualify for renewal.

How often do you have to renew your CNA in North Carolina?

On-time renewal of licensure will be for two (2) years and will expire the last day of your birth month. For initial licensure or reinstatement of a lapsed license, licensure may be for less than two (2) years [13-24 months] in order to place the expiration on the birth month.

What are the requirements for an individual to be listed on the N.C. nurse aide 1 registry?

To become a Nurse Aide I, one must do one of the following: Pass state-approved Nurse Aide I training and competency testing. Pass state-approved Nurse Aide I competency testing once a training waiver has been reviewed and approved. Request listing based on a qualified N.C. nursing license.

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What is DHHS Form DHHS/DHSR/HCPR-4510?

DHHS Form DHHS/DHSR/HCPR-4510 is a regulatory form used by the Department of Health and Human Services (DHHS) to gather specific information regarding healthcare provider compliance and reporting.

Who is required to file DHHS Form DHHS/DHSR/HCPR-4510?

Healthcare providers who are licensed or regulated by the DHHS are typically required to file DHHS Form DHHS/DHSR/HCPR-4510 as part of their compliance obligations.

How to fill out DHHS Form DHHS/DHSR/HCPR-4510?

To fill out DHHS Form DHHS/DHSR/HCPR-4510, follow the form's instructions carefully, providing all required information accurately, and ensuring all sections are completed before submitting.

What is the purpose of DHHS Form DHHS/DHSR/HCPR-4510?

The purpose of DHHS Form DHHS/DHSR/HCPR-4510 is to collect information needed for monitoring compliance with healthcare regulations and ensuring the quality and safety of healthcare services.

What information must be reported on DHHS Form DHHS/DHSR/HCPR-4510?

Information that must be reported includes provider identification details, service types offered, compliance status, and any incidents or changes in management, among other relevant data.