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[DOCX File]Connecticut
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Nov 04, 2020 · Education and/or training: a license-eligible individual whose education, training, skills and experience satisfy the criteria for any of the practitioner categories describe immediately above but who has not yet passed the licensure or certification exam; an individual with a minimum of an Associate’s Degree in a behavioral health related field or with two (2) years of college training in a ...
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[DOC File]Exhibit 5-3: Acceptable Forms of Verification
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Copy of separation or divorce agreement provided by ex-spouse or court indicating type of support, amount, and payment schedule. ... Driver’s license with SSN. Identification card issued by a federal, State, or local agency, a medical insurance provider, or an employer or trade union.
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[DOC File]“Example” Collaborative Practice Agreement for Advanced ...
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The advanced practice nurse shall make rounds at the request of the licensed practitioner and consult with the license practitioner as needed, etc. How they maintain geographic proximity: The licensed practitioner will maintain a physical presence within a reasonable geographic proximity to the advanced practice nurse’s practice location.
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[DOCX File]Connecticut Nurses’ Foundation COVID 19 Hero’s Fund
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The CT Nurses' Hero Fund gave the public an opportunity to support and thank nurses for their work during the COVID-19 pandemic. The funds collected to date have exceeded the $10,000 goal set in April 2020. The funds collected will be equally distributed to these categories: Nursing education scholarship for the future nurses in CT.
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[DOT File]Electronic Funds Transfer ACH (EFT) STATE OF CONNECTICUT
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Hartford, CT 06106-1775. If you choose to participate in this program: Altered forms will not be accepted. You must submit a signed copy of this form along with a signed W-9 and one form of account verification (Voided Check, Deposit Slip, Bank Letter). Upon approval, all
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CT.GOV-Connecticut's Official State Website
Submit a notarized application with photo, required fee payable to, “Treasurer, State of CT” (RN: $180, LPN: $150) and a copy of a current U.S. state license (licenses issued in jurisdictions other that the United States do not qualify an applicant for a temporary permit).
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[DOC File]COMPETENCY CHECKLIST (SAMPLE)
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I received a copy of the Standardized Emergency Codes (Policy or Badge-Buddy). I understand the Emergency Code procedures for the hospital and my role in patient safety. I agree with this competency assessment. I will contact my supervisor, manager or director if I require additional training in the future. Employee Signature: Date:
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[DOC File]MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
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Copy of signed service agreement(s). Radiation Safety Certificate DEQ Certification HFES Permit for Construction. FSOF/ASC License Hospital License Nursing Home License. Psych Inpatient Unit License. Patient Log - Date of 1st billable procedure/scan: (mm/dd/yyyy) All mobile host sites, please submit copy of HIPAA compliant patient log.
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[DOCX File]Collaborative Practice Agreement for Nurse Practitioner ...
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A copy of the collaborative practice agreement. The nurse practitioner will maintain documentation of completing 50 contact hours each year of AMA or ANCC approved continuing education courses. F. Review and Revision of collaborative practice agreement. This collaborative practice agreement will be reviewed, revised (if indicated), and signed ...
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[DOC File]Certificate of Need Application - RI Dept. of Health
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Pursuant to Section 1.7.1(A) of the rules and regulations, Licensing of Nursing Facilities (216-RICR-40-10-1), please demonstrate that the applicant or proposed license holder shall have sufficient resources to operate the nursing facility at licensed capacity for thirty (30) days, evidenced by an unencumbered line of credit, a joint escrow ...
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Copy of nursing license ct