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Get Ca Cdph 612 2011
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How to fill out the CA CDPH 612 online
The CA CDPH 612 form is essential for reporting nursing hours and patient census in skilled nursing facilities. This guide will assist you in accurately completing the form online, providing the clarity you need at each step.
Follow the steps to successfully fill out the CA CDPH 612 online.
- Click 'Get Form' button to obtain the form and open it in the editor.
- Enter the date of the patient day in MM/DD/YY format.
- Input the start time of the patient day in HH:MM AM/PM format. Ensure it's prospective; do not indicate that the patient day began at '11 PM the previous day'.
- Fill in the total number of licensed skilled nursing beds available in the facility.
- Provide the CDPH license number for the facility.
- Enter the name of the facility.
- Input the address of the facility.
- List the name of the facility administrator.
- Include the name of the individual who has Director of Nursing responsibilities for the day.
- Document the beginning census for the patient day and the total scheduled nursing hours. Calculate the scheduled NHPPD by dividing the scheduled nursing hours by the beginning census.
- Record daily census changes, including admissions, discharges, transfers, deaths, and other events. Enter the corresponding nursing hours for each shift and total nursing hours at the end of the census period.
- After the patient day concludes, calculate the average census by adding the three censuses and dividing by three. Record the actual nursing hours and calculate the final/actual NHPPD.
- The Director of Nursing or designee must review all entered information for accuracy and sign the form, verifying the data is complete and correct.
- Once all information is filled out, save changes, download, print, or share the completed form as necessary.
Complete your CA CDPH 612 form online to ensure accurate reporting of nursing hours and patient census.
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To file a complaint against a nursing home in California, you can contact the California Department of Public Health (CDPH) directly, or use their online complaint form. Provide details about the issue you're experiencing, as this information is vital for a thorough investigation. Your feedback plays an important role in maintaining standards in facilities overseen by the CA CDPH 612.
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