F-02726 |
Hand Hygiene (HH) and Personal Protective Equipment (PPE) Observations |
DPH |
English |
10/2020 |
PDF |
No |
F-02475 |
Hand Hygiene Observations |
DPH |
English |
06/2021 |
PDF |
No |
F-02989 |
Hazard Assessment Section Presentation Feedback |
DPH |
English |
03/2022 |
HTML |
No |
F-02382 |
HCBS Heightened Scrutiny Residential Provider Evidentiary Worksheet |
DMS |
English |
10/2018 |
Word |
No |
F-02383 |
HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary |
DMS |
English |
12/2020 |
Word |
No |
F-02383 |
HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary - 3-4 AFH |
DMS |
English |
01/2021 |
Word |
No |
F-02383 |
HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary - CBRF |
DMS |
English |
01/2021 |
Word |
No |
F-02383 |
HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary - RCAC |
DMS |
English |
01/2021 |
Word |
No |
F-02605A |
HCBS Settings Rule: Heightened Scrutiny Settings Review - Evidentiary Document Checklist |
DMS |
English |
09/2022 |
Word |
No |
F-02605A |
HCBS Settings Rule: Heightened Scrutiny Settings Review - Evidentiary Document Checklist , Instructions |
DMS |
English |
09/2022 |
PDF |
No |
F-00004B |
Health and Employment Counseling - I Have Reached Employment |
DMS |
English |
08/2018 |
PDF |
No |
F-00004A |
Health and Employment Counseling - I Think I Need More Time (PDF, 515 KB) |
DMS |
English |
08/2018 |
PDF |
No |
F-00004 |
Health and Employment Counseling Application |
DMS |
English |
06/2020 |
Word |
No |
F-00004 |
Health and Employment Counseling Application, Hmong |
DMS |
Hmong |
06/2020 |
Word |
No |
F-00004 |
Health and Employment Counseling Application, Spanish |
DMS |
Spanish |
06/2020 |
Word |
No |
F-43006 |
Health Care Employer Assurance for J-1 Visa Waiver Applications |
DPH |
English |
10/2018 |
PDF |
No |
F-62494 |
Health Care Facility Construction Documentation Checklist |
DQA |
English |
08/2020 |
Word |
No |
F-62494 |
Health Care Facility Construction Documentation Checklist |
DQA |
English |
08/2020 |
PDF |
No |
F-62500 |
Health Care Facility Fire Report |
DQA |
English |
10/2018 |
HTML |
No |
F-01062 |
HealthCheck Adolescent Review |
DMS |
English |
08/2019 |
PDF |
No |
F-01062 |
HealthCheck Adolescent Review |
DMS |
English |
08/2019 |
Word |
No |
F-01062 |
HealthCheck Adolescent Review, Spanish |
DMS |
Spanish |
08/2019 |
PDF |
No |
F-01062 |
HealthCheck Adolescent Review, Spanish |
DMS |
Spanish |
08/2019 |
Word |
No |
F-01066B |
HealthCheck Adolescent's Food Record (13 to 20 Years of Age) |
DMS |
English |
07/2008 |
Word |
No |
F-01066B |
HealthCheck Adolescent's Food Record (13 to 20 Years of Age) |
DMS |
English |
07/2008 |
PDF |
No |
F-01066B |
HealthCheck Adolescent's Food Record (13 to 20 Years of Age), Spanish |
DMS |
Spanish |
07/2008 |
Word |
No |
F-01066B |
HealthCheck Adolescent's Food Record (13 to 20 Years of Age), Spanish |
DMS |
Spanish |
07/2008 |
PDF |
No |
F-01066A |
HealthCheck Child's Food Record / 1 to 12 Years of Age |
DMS |
English |
07/2008 |
PDF |
No |
F-01066A |
HealthCheck Child's Food Record / 1 to 12 Years of Age |
DMS |
English |
07/2008 |
Word |
No |
F-01066A |
HealthCheck Child's Food Record / 1 to 12 Years of Age, Spanish |
DMS |
Spanish |
07/2008 |
Word |
No |
F-01066A |
HealthCheck Child's Food Record / 1 to 12 Years of Age, Spanish |
DMS |
Spanish |
07/2008 |
PDF |
No |
F-11289 |
HealthCheck County Outreach Case Management Plan for County |
DMS |
English |
09/2019 |
Word |
No |
F-11289 |
HealthCheck County Outreach Case Management Plan for County |
DMS |
English |
09/2019 |
PDF |
No |
F-01063 |
HealthCheck Family History |
DMS |
English |
08/2017 |
PDF |
No |
F-01063 |
HealthCheck Family History |
DMS |
English |
08/2017 |
Word |
No |
F-01063 |
HealthCheck Family History, Spanish |
DMS |
Spanish |
08/2017 |
PDF |
No |
F-01063 |
HealthCheck Family History, Spanish |
DMS |
Spanish |
08/2017 |
Word |
No |
F-01002 |
HealthCheck Individual Health History |
DMS |
English |
08/2019 |
PDF |
No |
F-01002 |
HealthCheck Individual Health History |
DMS |
English |
08/2019 |
Word |
No |
F-01002 |
HealthCheck Individual Health History, Hmong |
DMS |
Hmong |
08/2019 |
PDF |
No |
F-01002 |
HealthCheck Individual Health History, Hmong |
DMS |
Hmong |
08/2019 |
Word |
No |
F-01002 |
HealthCheck Individual Health History, Spanish |
DMS |
Spanish |
08/2019 |
Word |
No |
F-01002 |
HealthCheck Individual Health History, Spanish |
DMS |
Spanish |
08/2019 |
PDF |
No |
F-01066 |
HealthCheck Infant's Food Record (Birth to 12 Months of Age) |
DMS |
English |
07/2008 |
Word |
No |
F-01066 |
HealthCheck Infant's Food Record (Birth to 12 Months of Age) |
DMS |
English |
07/2008 |
PDF |
No |
F-01066 |
HealthCheck Infant's Food Record (Birth to 12 Months of Age), Spanish |
DMS |
Spanish |
07/2008 |
PDF |
No |
F-01066 |
HealthCheck Infant's Food Record (Birth to 12 Months of Age), Spanish |
DMS |
Spanish |
07/2008 |
Word |
No |
F-00021 |
HealthCheck Referral |
DMS |
English |
01/2017 |
PDF |
No |
F-11285 |
HealthCheck Screener Affirmation |
OIG |
English |
04/2022 |
PDF |
No |
F-11285 |
HealthCheck Screener Affirmation |
OIG |
English |
04/2022 |
Word |
No |