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Nursing Home Good Faith Efforts Attestation
(English, DOCX 73.81 KB)
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Circular Letter: #17-2-699 Revised Informed Consent for Use of Psychotropic Medications in LTCFs – 2/1/2017
(English, DOCX 68.99 KB)
This letter describes revised and updated policies that replace the policies and guidance published in the February 1, 2016 Circular Letter: DHCQ 16-2-653
Open DOC file, 48.5 KB,
#13-9-596 New Version of the Nursing Home Consumer Brochure 9/9/2013
(English, DOC 48.5 KB)
Open DOC file, 54.5 KB,
#13-9-595 Long Term Care Facility Respite Care Program 9/9/2013
(English, DOC 54.5 KB)
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Active Treatment Survey Document/Worksheet
(English, DOC 855.5 KB)
Open DOC file, 118 KB,
Active Treatment Survey Protocol
(English, DOC 118 KB)
Open RTF file, 43.5 KB,
#12-01-556 Electronic Transmission of Correspondence - 1/25/2012
(English, RTF 43.5 KB)
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DHCQ 11-01-545 - Care Transitions and Universal Transfer - 1/18/2011
(English, RTF 250.46 KB)
Open RTF file, 25.4 MB,
Universal Transfer Form and Instructions
(English, RTF 25.4 MB)
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Pediatric and Adolescent Resident
(English, XLS 45.5 KB)
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Adult Residents Aged 19 to 69
(English, XLS 38.5 KB)
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Elderly Residents Aged 70 or Older
(English, XLS 38.5 KB)
Open RTF file, 31 KB,
Attachment A - waiver or modification of requirements
(English, RTF 31 KB)
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Attachment B - EMTALA Fact Sheet
(English, RTF 171.5 KB)
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Attachment C - Requesting an 1135 Waiver
(English, RTF 47 KB)
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#09-04-509 Resident Transfer Agreements - 4/28/2009
(English, RTF 38 KB)
Open RTF file, 952.5 KB,
#08-04-485 LTCF Communications During an Emergency - 4/4/2008
(English, RTF 952.5 KB)
Open RTF file, 190.1 KB,
#06-4-459 Attestation for Continuity of Operations Plans (COOPs)
(English, RTF 190.1 KB)
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#05-09-452 Stock Medications - 9/30/2005
(English, RTF 106.71 KB)
Open RTF file, 54.47 KB,
#05-04-448 Do Not Resuscitate Orders - 4/8/2005
(English, RTF 54.47 KB)
Open RTF file, 214.93 KB,
#4-00-400 Unauthorized Use of DMH Form AA-1 -4/2002
(English, RTF 214.93 KB)
Open RTF file, 221.77 KB,
#02-04-424 Recall of Sprinkler Heads in Health Care Facilities 4/2/2002
(English, RTF 221.77 KB)