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D ZIP DATES OF REVIEW REVIEW NUMBER OPERATING CERTIFICATE NUMBER PROVIDER NUMBER PRU Number: PRU - Recertification + Joint Site Review (QA-3CD) (Applicable to Outpatient Programs, Outpatient Rehabilitation Programs, and Problem Gambling Designation) SECTION 1: PATIENT CASE RECORDS Gambling Program: SECTION 2: SERVICE MANAGEMENT SECTION 3: FACILITY REQUIREMENTS AND GENERAL SAFETY LEAD REGULATORY COMPLIANCE INSPECTOR NOTE: Pursuant to Mental Hygiene Law and the Office of Addiction Services.

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How to fill out the NY QA-3CD online

This guide provides a comprehensive overview of how to fill out the NY QA-3CD form online. It is designed to assist users at all levels, ensuring clarity and support throughout the process.

Follow the steps to successfully complete your NY QA-3CD form.

  1. Press the 'Get Form' button to access the NY QA-3CD form and open it in the online editor.
  2. Enter the provider legal name in the appropriate field, ensuring accuracy for compliance and identification.
  3. Fill in the statewide regional operations information as required, which may include regulatory compliance site review details.
  4. Input the program site address, city or town, and ZIP code in the designated sections to ensure proper location identification.
  5. Enter the review dates, review number, operating certificate number, and provider number accurately to maintain record integrity.
  6. Complete the PRU number section, specifying if it pertains to recertification and joint site review.
  7. Proceed to fill out Section 1: Patient Case Records. Enter identification numbers, first names, last name initials, and any comments relevant to each case reviewed.
  8. In the Patient Case Records section, mark compliance with a check in the appropriate columns, using '✓' for compliance and 'X' for non-compliance as instructed.
  9. Calculate the total compliance score for the Patient Case Records by dividing the total number of compliant cases by the total number of cases reviewed.
  10. Continue completing Section 2: Service Management and Section 3: Facility Requirements and General Safety by following similar instructions for fields and checks.
  11. Once all sections are completed, review the form for accuracy and completeness, ensuring all required fields are filled.
  12. Save your changes, and utilize options to download, print, or share the completed form as needed.

Complete your documentation online to ensure compliance and facilitate seamless operations.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232