0000004312 00000 n Adverse Reactions GBuLFk[@fx,m&l'lq~,%Ygmfv 1&-mff(,.2J)b?y_!mnuSbG1q1Q}RG1Q>>(>Jb(>/(>R(>Jbb(>R(>1=8M T1_\S"c"H)%RLC"iJL bH)J_ Lh endstream endobj 29 0 obj 506 endobj 30 0 obj << /Filter /FlateDecode /Length 29 0 R >> stream ')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 Other Required . 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. 0000002037 00000 n COMPLETED DOCUMENTATION ON MEDICATION ADMINISTRATION RECORD (MARS) If OTC, in the original box with student's name The information on the container must match the written order. 0000001853 00000 n 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. 0000069017 00000 n DDD Medicaid Providers - If your information is inaccurate, click the following link to download the. or call the PPL Customer Service Team at 1-844-842-5891. 0000006691 00000 n 2960 0 obj<> endobj %PDF-1.5 % S=eV*d={[`gY@:@BEx)m7h8.G/ Lzm?`$w5j*{_*^qU3d 0000004350 00000 n 0000003930 00000 n Doctors order form (Hold Harmless- signed by physician, parent) (Permission To Retain Form-signed by the physician, parent, and student) The medication in the original pharmacy container. Title: iRecord 3.0 User Guide. DDD Day Program Manual 11/06 Forms: Form F5 STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES - DIVISION OF DEVELOPMENTAL DISABILITIES Medical Form for Adults Name: _____ Age: _____ DOB: _____ { } Male { } Female . HIo1F+|FL.'$bX}C(U"Sv'$.T]~,w'&b,d.U|}=ZvTL6/.3/ne12%f9-XIrN-#kSntnzqzeWf~ [JBy'?//73[*>kv@sHx$L/~7g_UJt\sW7o,[k'gXFM0q9{8/629s~cH&)7cy1W#n c.Q4Qz{Xwkr 6)l},H!O.aMdsr4bPeDJA]s{wsZ3aMJy!5YH8Kmv!k@,/3!ZR&J8sL\0}jv Duty Area 6: Medication Administration Records (MARs) and other forms 61-68 . j)LdrJr+ew>ni\9)>9e3w]xW`C g0^:LhxG/KG~ pWO:+89MUozeu|:xbf}\Wy3CiSjr4~sNgW endstream endobj 21 0 obj << /Type /FontDescriptor /Ascent 905 /CapHeight 718 /Descent -211 /Flags 32 /FontBBox [ -665 -325 2028 1006 ] /FontName /OIIMPL+Arial /ItalicAngle 0 /StemV 94 /FontFile2 41 0 R >> endobj 22 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 146 /Widths [ 278 0 0 0 0 0 0 0 0 0 0 0 278 333 278 0 556 556 556 556 556 556 556 556 556 556 278 0 0 0 0 556 0 667 0 722 722 667 0 778 722 278 0 0 556 833 722 778 667 0 722 667 611 0 667 0 667 667 0 0 0 0 0 0 0 556 556 500 556 556 278 556 556 222 0 0 222 833 556 556 556 556 333 500 278 556 500 722 0 500 500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 222 ] /Encoding /WinAnsiEncoding /BaseFont /OIIMPL+Arial /FontDescriptor 21 0 R >> endobj 23 0 obj 745 endobj 24 0 obj << /Filter /FlateDecode /Length 23 0 R >> stream 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!! 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). Any changes or additional submission processes will be posted to the Department of Health website. New Jersey; New Mexico; New York; North Carolina . Application and Consent for Sterilization of Pets, Payment Voucher / Veterinarian Reimbursement, Animal Population Control Program Proxy Authorization, Rehabilitative Hospital and Special Hospital subject to a $10 Adjusted Admission Assessment, Asbestos Management Plan, Room/Functional Space Inspection, Request for Bacterial or Viral Culture or Parasite Identification, Application For Certificate of Approval To Operate a Youth Camp, Application For Certificate of Approval To Operate a Single Sport Youth Camp, Annual Accident Report Youth Camp Safety Act, Youth Camp Self-Inspection Report (for Youth Camp Operators), Youth Camp Safety Detailed Data Sheet (for Local Health Inspectors), Youth Camp Safety Detailed Data Sheet (for Youth Camp Operators), Certification for the Replacement of Main Drain Covers in Pool/Spa, Pediatric HIV Confidential Case Report Form, Typhoid And Paratyphoid Fever Surveillance Report, Cholera And Other Vibrio Illness Surveillance Report, Multisystem Inflammatory Syndrome Associated with COVID-19: Case Report Form, For Reporting Reportable Communicable Diseases, Patient Symptoms Line Listing (Respiratory Tract Infection), Patient Symptoms Line Listing (Gastrointestinal Infection). The PDD can be determined from studies of prescriptions, medical or pharmacy records, and it is important to relate the PDD to the diagnosis on which the drug is used. Initial Uniform Application for Services to Individuals 21 and Under with Developmental Disabilities: pdf (33k) doc (61k) FHS-18: . 0000006712 00000 n Google Translate is an online service for which the user pays nothing to obtain a purported language translation. 0000001144 00000 n 6. Medication Administration Record (MAR) Form D.401. Results 1 - 2 of 2. Disposing of Medications Demonstrates competency in agency policies and practices for proper medication d isposal. 0000000016 00000 n 0000028283 00000 n 0000007916 00000 n 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. dY?hG&sEFI, Z!r^tv *GP2|QY#'GlUnzvvRf:*EnxDtN d"a G/O)CFIc@hANwqK.DRtO)~>R>>^pJo3\?%_0'q0~LQo>E/"pO$Kc4h#P|CXvy3 xi7 2j Employee obtained key and opened box. Stay up to date on vaccine information. 0000009121 00000 n DDD has five policy manuals, which include the Operations, Medical, Eligibility, Behavior Supports, and Provider manuals. 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. Augusta, NJ 07822 Subject: Medication Departments Affected: All Programs Effective Date: 3/1/19 Replaces Policy: 10/9/87; 2/23/90; 4/15/92 . 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. $\Wy_3ww /ALBO>*$JqAR#$E7( *W'D3`Jvqz6$uhkqBk'AA$- 2\q>st-DRysdK+d4^+KP]Ve3IQiks8^K/+nc%mrm"}VX{^8Z xp9K`y_t PK ! endobj ), 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. PK ! 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 0000003719 00000 n "Community Services" means a component of the Division of Developmental Disabilities which provides housing and supportive services to aid persons with developmental disabilities in establishing themselves in the . Self-Directed Home Care for: State Programs. You may also contact Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017, [3] [4] [5] as well as paying for half of all U.S. births in 2019. trailer written medication administration records 4. Lt. Medication 20A Prescription Medication 20B PRN (as needed) Prescription Medication 20C PRN Over the Counter (OTC) Medication 20D Medication Storage 20E Medication Administration 21. Title: Medication Administration Record (MAR) Last modified by: ltolchin Created Date: 9/5/2008 4:12:00 PM Company: SDRC Other titles: Medication Administration Record (MAR) 0000004971 00000 n 0000009703 00000 n Employee ensured the packaging is secure and put everything back in the medication box. Authorization for Automatic Payments & Deposits 13. Concerns have previously been raised about the common use of paper-based medication administration records. A medication administration record to document any medications given as instructed in rule 65G-7.008, F.A.C. 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. Affirmative Action Survey (optional) 12. N _rels/.rels ( JAa}7 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 COVID-19 is still active. Financial 27. 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 Section 116.70 Medication Administration Record and Required Documentation Section 116.80 Storage and Disposal of Medications . Governor Sheila Oliver, Improving Health Through Leadership and Innovation, Guide to Completing Asbestos Management Plan Forms, Instructions for Completing Sample Submittal Forms, Instructions for Completing the Application for a Clinical Lab License, Guidelines for Requesting Certificates of Free Sale (Updated November, 2016), Immunization Reporting & Auditing Guidelines, Instructions for Completing the imm-20 Form, Guidelines for Uniform Shared Public Health Services Agreement, Additional Information for Completing the OCC-31 Form, NEW! !WWE` & endstream endobj 25 0 obj 505 endobj 26 0 obj << /Filter /FlateDecode /Length 25 0 R >> stream %PDF-1.4 % o word/_rels/document.xml.rels ( MO0H*wu] iWk:mDTZ-RkOU|ud$).s>'CV 9Y#j%W%v9GJ@1?*>%mb%`0_Lj&"'vVxk!$' 0000005847 00000 n Date: 2/15/2023. To receive Division Circulars, special alerts related to Division Circulars, and regulation updates by email, send a request to DDD-CO.LAPO@dhs.nj.gov and include your name, email address, and affiliaton (agency, individual, family, advocate, etc. 0000008521 00000 n The prescribed daily dose (PDD) is defined as the average dose prescribed according to a representative sample of prescriptions. 0000001233 00000 n cup, water, etc). The health care practitioner may utilize the Medication Administration Record Form, APD Form 65G-7.008 A, as adopted in rule 65G-7.008, F.A.C. \Jhzv).q&9Ln+wl!l1Z_1jK3\&OdCpgx1=GoeZr})@T{$W;0HOD#"MS\thh=K8g-R\B$g&C;%+_+L-|@7wahBX.jm=?3~_W1#l B&Nq_q##,_k@1-]5u vo{x!9 KNK 4 F word/_rels/document.xml.rels ( O0&K0 Wk^]oaare{~d+JIHREJ>Yd*gV5X2^_Mf^elJJRKV6+MAXt8A{F SOURCE: Emergency rule adopted at 23 Ill. Reg. HVnF}W(wI)dC&qdvZT J-g{H .3M\% 0000002533 00000 n 6o.m.=GZh&v#x[S}p_^wfobMimSMo5\Xu#. 3. 4 0 obj |[ N [Content_Types].xml ( n0ED'(,g6@][D9NP'Q-57,{87[gQ9[b2UJk-VB;%Ad7OCHmc+QX8Fj@V$Vg\:`1;Fcv- ew)d$6O#W@7"VR ? Y*H|KBGByMurUA ~wqNB'ne}r?Fs`j2Ng }M-"4**QoIt'&I[G4@F yu HZ}g=:y!BxduKrtxp`+sz'StJ7'.>\VI?\gHsUO6o , PK ! stream To receive Division Circulars, special alerts related to Division Circulars, and regulation updates by email, send a request to DDD-CO.LAPO@dhs.nj.gov and include your name, email address, and affiliaton (agency, individual, family, advocate, etc.) The Provider Search below allows users to search for providers by name or services. (fFv~V%446_s95O\+}CQd1e(2)BBDb6U)t!o.8 Gc>\L`hQlL`:pv*WmeG&FI$'z?bgX/("JR&ImgbjUi0uD(:^h2*8w!Q$$ kyDX>(un^,^.}4d.=\|qj2,$2BDCqmx82u%3]%R8K1bkV32;yD4+x]o?^ls!6xMA\8673`_t)\{ZFxzQiW !qDEfw/9vz@xZ=exH^Z!CNDZ1>(JstT8_F96ef Stokes Instructions for Completing the Record of Work Search You can Uia 6347 Michigan In addition to completing Form UIA 6347, you will also be asked to provide your:. If needed, an advocate from The Arc of New Jersey Family Institute can provide support to a family or individual who may need help completing the NJ CAT. 0000002840 00000 n 10:44B. individuals with developmental disabilities; however, these owner-occupied living arrangements are governed by N.J.A.C. 6 0 obj << /Linearized 1 /O 8 /H [ 1233 232 ] /L 77911 /E 76007 /N 1 /T 77674 >> endobj xref 6 40 0000000016 00000 n The Division of Developmental Disabilities Quality Improvement Jill Lewis, RN Performance Improvement Nurse Division of Developmental Disabilities Jlewis3@azdes.gov. DDD Day Program Manual 11/06 Forms: Form F(9) MEDICATION RECORD (must be completed in ink) NAME INITIALS Individual's Name: 1. 2960 19 <> Providers are responsible for updating DDD with their current information. 0000025606 00000 n Signatures Employee Name: ____________________________________ 0000002762 00000 n Call NJPIES Call Center for medical information related to COVID. 0000005208 00000 n H1Fa>WaZdqXUJz Xi[`Dy2lGmdnbv5? jF-ny8oO?[Z5z~au^?~uc SxmYwn#>9Vki?X82m Use PDF (NEW!) 0000002067 00000 n See reviews, photos, directions, phone numbers and more for Giant Food Inc And Giant Drug Padgetts Corner locations in Baltimore, MD. 75 0 obj <> endobj xref 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. 0000002475 00000 n hbbd``b`s " Defined as the average dose prescribed according to a representative sample of prescriptions? X82m pdf. 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