Get Ca Cdph 612 2019

The CA CDPH 612 form is essential for documenting the census and direct care service hours per patient day in skilled nursing facilities. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete the CA CDPH 612 online.

1. Use the ‘Get Form’ button to access the CA CDPH 612 online form and open it.
2. Enter the patient date in the format MM/DD/YY.
3. Input the total number of licensed skilled nursing beds for your facility.
4. Fill in the patient date start time using the format HH:MM AM/PM.
5. Enter the facility's CDPH license number.
6. Provide the facility name.
7. For scheduled total direct care service hours, input the total hours scheduled for the patient day. Record the beginning patient census at midnight, and the scheduled DHPPD will be calculated automatically.
8. Input the scheduled total CNA direct care service hours, which will also auto-calculate the scheduled CNA DHPPD.
9. Record daily census changes at 12:00 AM, 8:00 AM, and 4:00 PM, tracking admissions, discharges, transfers, and deaths. The ending census auto-populates as the beginning census for the next period.
10. At the end of the patient day, enter the actual total direct care service hours and actual total CNA direct care service hours.
11. The average patient census and actual DHPPD will be auto-calculated based on the information provided.
12. Finally, the Director of Nursing or their designee should review the information for accuracy and sign the form to verify that it is complete.

Complete your CA CDPH 612 form online today for accurate reporting.