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  1. Online Form 1 - Application for Licensure for Registered Professional Nurse. All applicants for licensure must initially submit Form 1 along with the $143 licensure and first registration fee. You must answer all questions and provide all information requested unless otherwise indicated.

    • Online Form 1

      All applicants for licensure must initially submit Form 1...

  2. Navigate to the HCS Nursing Home Incident Reporting Form. Click on NH Surveillance (listed under “My Applications” on the left side of your screen). Select “Data Entry” from the DataEntry menu. Select the activity “NH INCIDENT FORM”. Click on “Add New” to start reporting a new incident.

  3. As required by 18 NYCRR 487.7(d)(11); 488.7(b)(11); and 490.7(d)(9) adult homes, enriched housing programs, and assisted living residences (hereinafter referred to as Adult Care Facilities or ACFs) must convey reportable incidents to the New York State Department of Health (Department).

  4. This manual is available to all skilled nursing facility staff responsible for reporting alleged violations of mistreatment, neglect and abuse, including injuries of unknown source and misappropriation of resident property, to the New York State Department

  5. The Division of Nursing Homes and ICF/IID Surveillance, will be introducing a new electronic Facility Incident Reporting Form, and will require nursing homes to report their incidents through a web-based survey application.

  6. The amount and type of nursing supervision shall be determined by the registered professional nurse responsible for supervising such task based upon the complexity of the tasks, the skill and experience of the direct support staff, and the health status of the individual being cared for; (6) a direct support staff shall not be authorized to ...

  7. Please note that the Facility Survey Report is a single omnibus form which applies to all government, voluntary, and proprietary nursing homes. The following specific instructions are to be followed: KEEP A BLANK MASTER FSR AND MAKE COPIES AS NEEDED. 1. Complete the facility name and permanent facility identifier (PFI) on

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