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Get CA CDPH 530 2011-2022

Facility name. Enter the date of the patient day in MM/DD/YY format. Enter the name of the person who has Director of Nursing responsibility for the day. Circle the appropriate shift: one, two or three. Enter the shift start time in HH:MM AM/PM format. If applicable, enter the name of the specific location in the facility for the patient assignments. Record only direct caregivers not otherwise captured in payroll records. Enter the specific patient assignment and the employee’s name responsibl.

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