nj ddd medication administration record

4Rym_0' 13102 0 obj <>/Filter/FlateDecode/ID[<766194F1420B4A419B34A3B3CCFB1DFB>]/Index[13094 17]/Info 13093 0 R/Length 59/Prev 856776/Root 13095 0 R/Size 13111/Type/XRef/W[1 2 1]>>stream 0000004350 00000 n ), Catastrophic Illness in Children Relief Fund (CICRF), Commission for the Blind & Visually Impaired (CBVI), Division of the Deaf & Hard of Hearing (DDHH), Division of Developmental Disabilities (DDD), Division of Medical Assistance & Health Services (DMAHS), Division of Mental Health and Addiction Services (DMHAS), Office for Prevention of Developmental Disabilities, Office of Program Integrity & Accountability, Public Advisory Boards, Commissions & Councils, Memo from Deputy Commissioner Apgar regarding rescinding DC #33, Assistant Commissioner Ritchey Letter regarding Division Circular #34, Behavior Support Plans, DEVELOPMENT AND PROMULGATION OF DIVISION CIRCULARS AND QUALITY ENHANCEMENT PROCEDURES, CONTRIBUTION FOR CARE AND MAINTENANCE REQUIREMENTS, MANAGEMENT OF FUNDS WHERE DDD OR THE PROVIDER IS REPRESENTATIVE PAYEE FOR AN INDIVIDUAL'S BENEFITS, PRINCIPLES AND GOAL OF THE DIVISION OF DEVELOPMENT DISABILITIES, GUARDIANSHIP: NEED, APPOINTMENT, CONTINUITY, COMMUNITY CARE WAIVER WAITING LIST PROCEDURES, COMPLAINTS FILED UNDER THE AMERICANS WITH DISABILITIES ACT (ADA), COMPLAINT INVESTIGATIONS IN COMMUNITY PROGRAMS, DEFENSIVE TECHNIQUES AND PERSONAL CONTROL TECHNIQUES, MECHANICAL RESTRAINT AND SAFEGUARDING EQUIPMENT, REFERRALS FOR PLACEMENT FROM DEVELOPMENTAL CENTERS AND TRANSFERS TO COMMUNITY LIVING ARRANGEMENTS, REPRESENTATION, INDEMNIFICATION, AND EXPUNGEMENT OF ARREST RECORDS OF DIVISION EMPLOYEES AND FORWARDING OF LEGAL PAPERS, RECORDS CONFIDENTIALITY AND ACCESS TO CLIENT, DIVISIONAND PROVIDER RECORDS, AUTHORIZATION FOR EMERGENCY MEDICAL, SURGICAL, PSYCHIATRIC OR DENTAL TREATMENT, TRANSFER OR DISCHARGE FROM CONTRACTED PROVIDER, DEATH AND FUNERAL ARRANGEMENTS OF A PERSON RECEIVING SERVICE, PAYMENTS TO OPERATORS OF COMMUNITY CARE RESIDENCES (, SKILL LEVEL DETERMINATION AND COMPENSATION, PLACEMENTS FROM COMMUNITY SERVICES INTO PSYCHIATRIC HOSPITALS, COMMUNITY SERVICES SYSTEM OF CASE MANAGEMENT, HIPAA-ADMINISTRATIVE POLICIES AND PROCEDURES, HIPAA-USES AND DISCLOSURES POLICIES AND PROCEDURES, HIPAA-CLIENT RIGHTS POLICIES AND PROCEDURES, Federal Deficit Reduction Act of 2005, Section 6032 - Policy on Fraud, Waste and Abuse, Federal Deficit Reduction Act of 2005, Section 6032 - Policy on Compliance. {0W\93*-ajwB}2M1C:4\#{p3gzQ1.vg6~dA<4?A;@R^gi7@|O1yZyG$#l]L< R95~NBUWb8)'j %%EOF R-Refused by Individual 3. . <> The prescribed daily dose (PDD) is defined as the average dose prescribed according to a representative sample of prescriptions. !WWE` & endstream endobj 25 0 obj 505 endobj 26 0 obj << /Filter /FlateDecode /Length 25 0 R >> stream Application for Approval to Operate a Body Art Establishment (Temporary) For use by Local Health Department Officials only. . xref dpcC0Hj=]bTj[+e uLgJ3!hTT/YKg91I=Q>U8plo' qQ,Nj@#7.l>. Other Required . Adult Medical Day Care Inspection Information, Pediatric Medical Day Care Inspection Information, Affidavit of Compliance Assisted Living Residences, Comprehensive Personal Care Homes and Assisted Living Programs, Affidavit of Compliance with N. J. Licensure Standards for Adult Day Health Care Facilities, Declaration of Compliance with Advisory Standards, Consumer Resident/Patient Complaint Report, Affidavit of Compliance with N. J. Licensure Standards for Pediatric Medical Day Care Facilities. individuals with developmental disabilities; however, these owner-occupied living arrangements are governed by N.J.A.C. 0000009703 00000 n 10:44B. 0000005319 00000 n You can use Facility Locator to locate your nearest .A veteran is entitled to an annual clothing allowance for each prosthetic or orthopedic appliance (including, but not limited to, a wheelchair) or medication used by the veteran if Clothing Allowance is a single, annual allowance paid out to the veteran, in the sum of $753. The State of NJ site may contain optional links, information, services and/or content from other websites operated by third parties that are provided as a convenience, such as Google Translate. medication(s) for MAID. All over-the-counter medications being administered to the client must have a written physician's order documented in the client's record per Section 17a-210-6. Medication Administration | Providers APD > Medication Administration Florida Administrative Code Rule Chapter 65G-7 APD Form 65G-7.008 - Medication Administration Record (MAR) PDF - MS Word APD Form 65G-7.002A - Authorization for Medication Administration PDF APD Form 65G-7.002B - Informed Consent for Medication Administration PDF DDD develops policies that conform to state, federal, and contractual requirements. 3. Medication 20A Prescription Medication 20B PRN (as needed) Prescription Medication 20C PRN Over the Counter (OTC) Medication 20D Medication Storage 20E Medication Administration 21. Disposing of Medications Demonstrates competency in agency policies and practices for proper medication d isposal. New Jersey; New Mexico; New York; North Carolina . Application to Amend a New Jersey Vital Record / Application for a Certified Copy of Amended Record (Updated February 7, 2019) pdf . ')h>-J*EgR=pIRX~%f"5J9rirf(peAeKlK>LEOQeK>Zc,g%f.3I=NM+n3:{c}~n]G.H[?r~/;+~.>-,|O`ws`"b")1HWJ3%Dy&HgH+%tD:?L%JtD:C"])HWJ3%JtDnDR")_Hz%_rmC!ba(fD#Jh~lh4Q{0zfTfDA3=Ho e3 endstream endobj 27 0 obj 501 endobj 28 0 obj << /Filter /FlateDecode /Length 27 0 R >> stream 82 Homes For Sale in Augusta County, VA. Rahiem Brent. fao.b*lIrj),l0%b The user is on notice that neither the State of NJ site nor its operators review any of the services, information and/or content from anything that may be linked to the State of NJ site for any reason. Any changes or additional submission processes will be posted to the Department of Health website. PK ! Service Plan 24. 0000002037 00000 n DDD Day Program Manual 11/06 Forms: Form F5 STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES - DIVISION OF DEVELOPMENTAL DISABILITIES Medical Form for Adults Name: _____ Age: _____ DOB: _____ { } Male { } Female . Medication Administration Medication Administration Medication administration training and certification developed by DODD authorizes caregivers to perform a variety of tasks for people with many different medical conditions. Other Suggested Searches . Employee washed hands and gathered all necessary supplies (e.g. 0000004088 00000 n o~^t|??hM2Wto>?y Y2t"rc. Microsoft Word - F9 Medication Administration Record.doc Date of Report . Medication Disposal Record Form MCAR 023-080-585 Unused, outdated, discontinued, recalled, or contaminated medications, including controlled substances, shall not be kept in the home and shall be disposed of according to federal Catastrophic Illness in Children Relief Fund (CICRF), Commission for the Blind & Visually Impaired (CBVI), Division of the Deaf & Hard of Hearing (DDHH), Division of Developmental Disabilities (DDD), Division of Medical Assistance & Health Services (DMAHS), Division of Mental Health and Addiction Services (DMHAS), Office for Prevention of Developmental Disabilities, Office of Program Integrity & Accountability, Public Advisory Boards, Commissions & Councils, Office of Education of Self-Directed Services. Y$M6R};gK~#w0G]VrsN}y6:n$RgWl{OW?f\)*UT)TzhXuK. Accessibility. 0000001144 00000 n o word/_rels/document.xml.rels ( MO0H*wu] iWk:mDTZ-RkOU|ud$).s>'CV 9Y#j%W%v9GJ@1?*>%mb%`0_Lj&"'vVxk!$' From Wikimedia Commons, the free media repository. ; 3. New Jersey DoH presents 'Requests for In-Home Vaccination'. %%EOF Application for Temporary Marketing Permit: Renewal Application to Operate a Bulk Tank Unit/Milk Plant, Mental Health Professional Compliance Form, Request for Medication To End My Life in a Humane and Dignified Manner, Attestation for Compliance with Wavier Requirements to Provide Medications for the Treatment of Substance Use Disorder (MH), Faithful Families Eating Smart and Moving More, Application for Approval of a Certified Medication Aide Training and Competency Evaluation Program (MATCEP) in Assisted Living Residences / Assisted Living Programs / Comprehensive Personal Care Homes, Addendum: CMA Training - List of Course Attendees, Application for Nursing Home Administrator License, Sponsor Application for Continuing Education Program Approval for Licensed Nursing Home Administrators, Application for Approval of Administrative Intern Program, Certification of Program Completion for Nursing Home Administrative Intern Program, Institutional Approval of Intramural Research, Agreement for Ethical Conduct of Human Subjects Research, Agreement for Ethical Conduct of Human Subjects Research (Federal Employees), Notice of Claim of Exemption of Tobacco Retail Establishment, Application for Registration of Exempt Cigar Bar or Lounge, Application for Renewal of Registration of Exempt Cigar Bar or Lounge, NJ Smoke Free Air Act / Anonymous Request for Investigation, Public Employees Occupational Safety and Health (PEOSH) Unit Request for On-Site Consultation, EMS Respiratory Protection Program Evaluation Questionnaire, PEOSH Respirator Medical Evaluation Questionnaire, Firefighter Respirator Medical Evaluation Questionnaire, Documentation of Medical Evaluation for Respirator Use, Occupational and Environmental Disease, Injury, or Poisoning Report by Health Care Provider, Firefighter SCBA After Use/Daily Inspection Checklist, Clinical Laboratory Report of Elevated Levels of Heavy Metals:Lead: In Adults (Greater than 16 Years of Age)Arsenic, Cadmium, Mercury: In Persons of Any Age, PEOSH Hazard Communication Standard, Documentation of Training, Sample Letter for Requesting Safety Data Sheets (SDS's), Worker and Community Right to Know Act / Employer Outreach Survey, Quarterly Report of RTK County Lead Agencies, Public Employees Occupational Safety and Health (PEOSH) Unit Complaint, J-1 Visa Waiver / State Conrad 30 Program - Physician-Primary Care Survey, Initial/Biannual Service Report, J-1 Visa Waiver / State Conrad 30 Program - Application for New Jersey, Attachment A: Current Medical Staffing at Practice Site, Attachment B: Health Care Resources Inventory, Attachment C: Facility Current Sliding Fee Scale, Attachment D: J-1 Physician Visa Waiver / State Conrad 30 Program - Statements, Section 4-1, Health Facility's J-1 Visa Waiver / State Conrad 30 Program - Agreement, Section 4-2, Physician J-1 Visa Waiver / State Conrad 30 Program - Affidavit and Agreement, Section 5, J-1 Visa Waiver Required Application Enclosures, American Cancer Society (ACS) Monthly Activity Report, Mom's Quit Connection (MQC) Monthly Activity Report, Requisition for Printing and Graphic Design, Application for Tanning Facilities Registration, Signature Page, Acknowledging Receipt of Grant Agreement for Special Health Projects, Confidential Medical Waste Exposure Report, Questionnaire to Assess Your Exposure Risk for Lead and Mercury (Quicksilver), Radioanalytical Services Sample Submittal, Quarterly Report of Domestic Partnerships Registered, Delegation of Authority to Receive Certified Copy of Vital Record (Birth/Death), Delegation of Authority to Receive Certified Copy, Report of No Births, Marriages, Civil Unions, Domestic Partnerships or Fetal Deaths, Application for a Certified Copy of a "No Record of Marriage" Statement (English/Spanish), Certified Municipal Registrar Recertification Course Tracking Log, Application to Amend a New Jersey Vital Record /, Authorization for Release of Cause of Death, APLICACIN PARA COPIAS CERTIFICADAS CERTIFICACIONES DE REGISTROS CIVILES, APLICACIN POR UNA COPIA CERTIFICADA CERTIFICACIONES DE UN REGISTRO CIVIL, Correcting a Birth Record for Child Whose Natural Parents Married After Its Birth. Medication Administration - "You Are Your Brother's Keeper" Initial Uniform Application for Services to Individuals 21 and Under with Developmental Disabilities: pdf (33k) doc (61k) FHS-18: . 30230uq00`Xpi\'00``l``r;"7Iu%4of #C endstream endobj 45 0 obj 120 endobj 8 0 obj << /Type /Page /Parent 3 0 R /Resources 9 0 R /Contents [ 20 0 R 24 0 R 26 0 R 28 0 R 30 0 R 32 0 R 34 0 R 36 0 R ] /Rotate 90 /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] >> endobj 9 0 obj << /ProcSet [ /PDF /Text ] /Font << /TT2 14 0 R /TT4 12 0 R /TT6 16 0 R /TT8 17 0 R /TT10 22 0 R >> /ExtGState << /GS1 43 0 R >> /ColorSpace << /Cs6 18 0 R >> >> endobj 10 0 obj << /Type /FontDescriptor /Ascent 905 /CapHeight 718 /Descent -211 /Flags 32 /FontBBox [ -628 -376 2034 1010 ] /FontName /OIIMNH+Arial,Bold /ItalicAngle 0 /StemV 144 /FontFile2 40 0 R >> endobj 11 0 obj << /Type /FontDescriptor /Ascent 891 /CapHeight 0 /Descent -216 /Flags 34 /FontBBox [ -568 -307 2028 1007 ] /FontName /OIIMOJ+TimesNewRoman /ItalicAngle 0 /StemV 0 /FontFile2 37 0 R >> endobj 12 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 32 /Widths [ 250 ] /Encoding /WinAnsiEncoding /BaseFont /OIIMMG+TimesNewRoman,Italic /FontDescriptor 15 0 R >> endobj 13 0 obj << /Type /FontDescriptor /Ascent 905 /CapHeight 0 /Descent -211 /Flags 96 /FontBBox [ -517 -325 1082 998 ] /FontName /OIIMME+Arial,Italic /ItalicAngle -15 /StemV 0 /FontFile2 38 0 R >> endobj 14 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 114 /Widths [ 278 0 0 556 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 556 0 0 0 0 0 0 0 0 0 0 0 0 611 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 833 0 556 0 0 333 ] /Encoding /WinAnsiEncoding /BaseFont /OIIMME+Arial,Italic /FontDescriptor 13 0 R >> endobj 15 0 obj << /Type /FontDescriptor /Ascent 891 /CapHeight 0 /Descent -216 /Flags 98 /FontBBox [ -498 -307 1120 1023 ] /FontName /OIIMMG+TimesNewRoman,Italic /ItalicAngle -15 /StemV 0 /FontFile2 42 0 R >> endobj 16 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 121 /Widths [ 278 0 0 0 0 0 0 0 333 333 0 0 0 0 0 278 556 556 0 0 0 0 556 0 0 556 333 0 0 0 0 0 0 722 0 722 722 667 611 0 0 278 0 0 0 833 722 778 667 0 722 0 611 0 0 0 0 0 0 0 0 0 0 0 0 556 611 556 611 556 0 611 0 278 0 556 278 889 611 611 611 0 389 556 333 611 0 0 0 556 ] /Encoding /WinAnsiEncoding /BaseFont /OIIMNH+Arial,Bold /FontDescriptor 10 0 R >> endobj 17 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 32 /Widths [ 250 ] /Encoding /WinAnsiEncoding /BaseFont /OIIMOJ+TimesNewRoman /FontDescriptor 11 0 R >> endobj 18 0 obj [ /ICCBased 39 0 R ] endobj 19 0 obj 1065 endobj 20 0 obj << /Filter /FlateDecode /Length 19 0 R >> stream Contact providers directly for more details about whether they currently provide services in your area and if they are a suitable match for you or your family member. 3 0 obj Hb``Pc``, p@i Duty Area 8: Organize to Administer Medications to Residents 77-80 . Long Term Care Systems, New Jersey Department of Health and Senior Services, who contributed their time, knowledge, and talents to the development and revisions of this . follow up DDD Medication Administration Assessment can be administered. PK ! 8.2 Medication records shall carry the following essential information: 8.2.1 Member's name 8.2.2 Name and strength of drug 8.2.3 Route of administration In the future, additional features will be available, including the ability to search by radius around a zip code, catchment area and by keywords. 0000075899 00000 n 0000003946 00000 n 0000001853 00000 n 2960 19 For more information and to review Training Reimbursement Payment FAQ, please visit PPL's NJ DDD Program webpage at . 0 0000006691 00000 n \Jhzv).q&9Ln+wl!l1Z_1jK3\&OdCpgx1=GoeZr})@T{$W;0HOD#"MS\thh=K8g-R\B$g&C;%+_+L-|@7wahBX.jm=?3~_W1#l B&Nq_q##,_k@1-]5u vo{x!9 KNK Developmental Disabilities Administrative Act [20 ILCS 1705/15.4]. 0000005868 00000 n dg>$)7k/W5Ro)G|>BfB0&9c3ADeh;sCYLQ]vY*TQLa.$'hE.i, /%C _`wML}w`6Bxp^ PK ! All Files Are In PDF Format Use PDF (NEW!) The user is on notice that neither the State of NJ site nor its operators review any of the services, information and/or content from anything that may be linked to the State of NJ site for any reason. 1 0 obj Adverse Reactions Contact us 732.246.2525 x38 or x24 or at thefamilyinstitute@arcnj.org. Employee signed and initialed the medication administration record/sheet if administering medications for the first time that mo nth on that sheet. Division Circulars are documents issued by the Assistant Commissioner that set policy for the various agencies within the Division of Developmental Disabilities. "Hw"w P^O;aY`GkxmPY[g Gino/"f3\TI SWY ig@X6_]7~ HCANJ | New Jersey (NJ) NursingCenter and Assisted Living Providers "Hw"w P^O;aY`GkxmPY[g Gino/"f3\TI SWY ig@X6_]7~ The New Jersey Registered Pharmacist shall also be required to complete the one-day orientation course. 0000004971 00000 n 0000009121 00000 n fillable PDF form - use Adobe Reader (click to download Reader), Instructions for Completing the PHSS-5 Payment Voucher, Guidelines (Guia), (English/espaol) (REG-D34), Instructions for Completion of TB-70 Form, Instructions for Submission of Specimens (packaging and transport), Instructions for State-Sponsored Municipal Rabies Vaccination Clinics, Policies and Guidelines for Animal Rabies Vaccination. 0000001233 00000 n 2. <>/Metadata 553 0 R/ViewerPreferences 554 0 R>> 0000000016 00000 n N _rels/.rels ( JAa}7 To receive Division Circulars, special alerts related to Division Circulars, and regulation updates by email, send a request to DDD-CO.LAPO@dhs.nj.gov and include your name, email address, and affiliaton (agency, individual, family, advocate, etc. endobj 0000003930 00000 n Lt. written medication administration records 4. 6. 0000005208 00000 n To receive Division Circulars, special alerts related to Division Circulars, and regulation updates by email, send a request to DDD-CO.LAPO@dhs.nj.gov and include your name, email address, and affiliaton (agency, individual, family, advocate, etc.) Hn$1aOaS\.,&,$rEc,h>uJWJ!Uj2Ky 3e5bFe3YO1Q"T7k!lUb. endstream endobj startxref -Read Full Dislaimer. 2 0 obj Providers are responsible for updating DDD with their current information. Title: iRecord 3.0 User Guide. Rn/ 3 0000044951 00000 n Discontinuing Medications Demonstrates competency in agency policies and practices for proper documentation of the discontinuation of a medication 5. 10:161A, Symptom Assessment for Pulmonary Tuberculosis (TB), Religious Exemption - School TB Testing/Symptom Assessment Form, Statement of Non-Infectiousness for Symptomatic Individual, Statement of Non-Infectiousness for Individual with TB Disease, Record of Contact Interview (Original + 1 Continuation Page), Record of Contact Interview (Original + 2 Continuation Pages), Record of Contact Interview (Original + 5 Continuation Pages), New Jersey Tuberculosis Case, Suspect and Status Report, Vaccine Adverse Event Reporting System: Online, Inspection Report of Kennels, Pet Shops, Shelters, and Pounds, List of Licensed Kennels, Pet Shops, Shelters and Pounds, Certification of Veterinary Supervision of the Disease Control and Health Care Program at a Licensed Animal Facility, Notice of Intent, State-Sponsored Municipal Rabies Vaccination Clinics, State-Sponsored Municipal Rabies Vaccination Clinic Report, Certificate of Exemption from Rabies Vaccination, Application for Animal Control Officer Certification, Medical Documentation for WIC Formula and Approved WIC Foods for Infants, Children and Women, Designation of Infant Formula Manufacturer, Retailer, Wholesaler and Distributor, Vendor Agreement (without signature page), Authorization AGreement for DirectDeposit (ACH) Credits, NJ WIC Health Care Referral (Infants and Children). With MAR, users can schedule and add comments to medications and treatment records, and export MAR reports with current medications and treatments on a monthly grid. !V]Bu b%KHU. Google Translate is an online service for which the user pays nothing to obtain a purported language translation. <<24848f9e8f2e254bbc6cfc72265c29d0>]>> $\Wy_3ww /ALBO>*$JqAR#$E7( 12 The eMAR system used in this study proved to be beneficial in this respect, as the perceived risk of medication errors occurring during the medication administration process due to inaccurate medication administration records decreased Unusual Incidents 22. Provisions for the utilization of a Medication Administration Record (MAR) for all medicinal drugs administered to patients of the facility. 0000002688 00000 n 0000002067 00000 n hUhUk+?ijmfBcrk8n:i9*h+"(l#QhC:0pJ%1w~y 9 F(_[@B Mailing Address: Administrative Office PO Box 726 Trenton, NJ 08625-0726 Office: Department of Human Services building 222 South Warren Street Trenton, NJ 08625-0700 2023 February 2023 February 7, 2023 !!NEW!! 0 Completion of the Medication Module on CDS prior to July 1, 2014 will not be accepted for pre-service requirements. 0000003968 00000 n You may filter your search results further by services, provider location, location type, etc., or use a combination of searches and filters to browse provider options. 75 0 obj <> endobj Kl],q,[-?A%v fw{XJMqxh iugdnNuSscWJ The Division of Developmental Disabilities Quality Improvement Jill Lewis, RN Performance Improvement Nurse Division of Developmental Disabilities Jlewis3@azdes.gov. 0000008500 00000 n ADM #2022-05 Medication Administration Training Curriculum for Direct Support Staff Download Form 811-DI (Diabetes Care Certification Record) Download Form 811-TF (Tube Feeding Certification Record) Download Form 811- AMAP (Medication Administration Certification Record) Download Form 811- COL (Colostomy Certification Record) Download DHS Offers Webinar on Newly Released Regulations Notice to Enrollee 11. endobj Employee ensured the packaging is secure and put everything back in the medication box. 94 0 obj <>/Filter/FlateDecode/ID[<6D5C50C2AFF7224EAED42BD0CCE5FA85>]/Index[75 30]/Info 74 0 R/Length 95/Prev 122963/Root 76 0 R/Size 105/Type/XRef/W[1 3 1]>>stream Hemolytic Uremic Syndrome (Postdiarrheal) Report, Epidemiology Surveillance Record (Hospital-Based Laboratory), Report of Known or Suspected Avian Chlamydiosis (Psittacosis), Outbreak Report for Long Term Care and Other Institutions, Outbreak Report for Child Care, School and Camp Settings, Child Care Center - DOH Subsequent Notification, Statement of Education and Experience Requirements, Checklist for Public Recreational Bathing Facilities, Notification of Non-Friable Asbestos Work Activities, Notification of Non-Friable Asbestos Work Activities Related to Superstorm Sandy, Contractor Information for Non-Friable Asbestos Work Activities, Body Art or Ear-Piercing Establishment Report of Infection or Injury, Physician Report Form (Non-Hospital Source), Application for Cottage Food Operator Permit, Child Health Conference - Health Assessment (Infancy: 2-6 Weeks), Child Health Conference - Health Assessment (Infancy: 2 Months), Child Health Conference - Health Assessment (Infancy: 4 Months), Child Health Conference - Health Assessment (Infancy: 6 Months), Child Health Conference - Health Assessment (Infancy: 9 Months), Child Health Conference - Health Assessment (Infancy: 12 Months), Child Health Conference - Health Assessment (Childhood: 15 Months), Child Health Conference - Health Assessment (Childhood: 18 Months), Child Health Conference - Health Assessment (Childhood: 2 Years), Child Health Conference - Health Assessment (Childhood: 3 Years), Child Health Conference - Health Assessment (Childhood: 4 Years), Child Health Conference - Health Assessment (Childhood: 5 Years), Child Health Conference - Health Assessment (Childhood: 6 Years), Child Health Conference - Health Assessment (Childhood: 7 Years), Child Health Conference - Health Assessment (Childhood: 8 Years), Child Health Conference - Health Assessment (Childhood: 9 Years), Child Health Conference - Health Assessment (Childhood: 10-12 Yrs), Child Health Conference - Health Assessment (Childhood: 13-15 Yrs), Child Health Conference - Health Assessment (Childhood: 16-20 Yrs), Child Health Services Quarterly Summary Report, Care Plan for Children with Special Health Needs, Organic and Inorganic Chemistry Sample Submittal, Application for a Clinical Laboratory License, Blood Bank Annual Statistics (Out of Hospital and Emergency Only Transfusion Facilities), Disclosure of Ownership and Control Interest, Blood Bank Annual Statistics (Umbilical Cord Blood Facilities), Laboratory Personnel Qualification Appraisal, Blood Bank Personnel Qualification Appraisal, Brokers and Reagent Manufactureres - Annual Statistical Data, Request for Funding from Civil Monetary Penalties, Clinical Laboratory Improvement Amendments (CLIA) Application for Certification, Full Review Certificate of Need Application for Long Term Care Facilities: General Long Term Care Beds; Specialized Long Term Care Beds, Application for Certificate of Need for Hospital-Related Projects, Application for Certificate of Need for Designation as a Perinatal Facility, Project Application for an Adult Day Health Services Facility, Application for New or Amended Acute Care Facility License, Project Application for Expansion Slots at a Licensed Adult Day Health Services Facility, Health Care Facility Inquiry Regarding Health Care Professional (HFEL-9) (updated August 10,2017), Annual Report of Megavoltage Radiation Unit, Surgical Practice Application for Registration, Renewal, Relocation, Transfer of Ownership (Formerly HFEL-8), Certificate of Need Application-Expedited Review for Facilities and Services Identified at NJAC 8:33-5.1(a), HIV Confidential Consent Form (Serology) (spanish), HIV Consent (Rapid Testing) - Confidential and Anonymous Testing, HIV Consent (Rapid Testing) (Confidential and Anonymous) (spanish), HIV Consent (Rapid Testing) (Confidential and Anonymous) (Creole), HIV Consent (Rapid Testing) - Confidential Testing Only, HIV Consent (Rapid Testing) (Confidential Only) (spanish), HIV Consent (Rapid Testing) (Confidential Only) (Creole), Application for Eligibility for the HIV Home Care Program, Pediatric HIV/AIDS Confidential Case Report, Renewal Application for Lead Training Agency Certification, Initial Application for Asbestos Training Agency Certification, Renewal Application for Asbestos Training Agency Certification, Application for Reciprocal Asbestos Accreditation, Application for Approval as a NJ Asbestos Course Instructor, Application for Approval as a NJ Lead Course Instructor/Training Manager, Application for Lead Permit Worker-Housing and Public Buildings, Application for Lead Permit Supervisor, Housing and Public Buildings, Application for Lead Permit Inspector/Risk Assessor, Application for Lead Permit Planner/Project Designer, Application for Lead Permit Worker, Commercial Buildings and Superstructure, Application for Lead Permit Supervisor, Commercial Buildings and Superstructures, Initial Application for Lead Training Agency Certification, Application for Replacement of Lead Permit. 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