Mass dph forms

    • [DOCX File]Abbott BinaxNOW Sample Consent Forms

      https://info.5y1.org/mass-dph-forms_1_709b58.html

      Abbott BinaxNOW Antigen Test for Symptomatic Individuals. Sample Parent/Guardian Authorization for Student. By completing and submitting this form, I confirm that I am the appropriate parent / guardian to provide consent, and that I authorize the administration of a COVID-19 antigen test on my student during school hours, should school staff observe …

    • Mass.Gov

      The report from the health care facility to the designated infection control officer to you is confidential and is governed by M.G. L. c.111, §111C and DPH regulations 105 CMR 170.000, 171.000 and 172.000.

    • [DOCX File]Resource Request Form OPEM Abbott BinaxNOW Test Kits for ...

      https://info.5y1.org/mass-dph-forms_1_9557dd.html

      COVID19.Resource.Request@mass.gov *Request forms should only be submitted after a school / district has sent their Readiness Review Checklist attestation form to DESE and has received approval to begin requesting test kits, as is detailed in the Phase 1 Abbott BinaxNOW K-12 Testing Program Memo & Checklist.

    • [DOCX File]Required In-service Training for Nursing Homes

      https://info.5y1.org/mass-dph-forms_1_281fdc.html

      Required Training and In-services for Nursing Homes. The required training and in-services for nursing home employees are grouped into several categories: General requirements, abuse prevention and reporting requirements, safety requirements, infection control and prevention requirements, and specialized requirements for identified employees.

    • Background

      The Massachusetts COVID-19 Command Center, in collaboration with the Massachusetts Department of Public Health (DPH) is making BinaxNOW test kits available for use at nursing homes and rest homes (LTC facilities) for the purpose of testing visitors and symptomatic residents and staff, at no cost to the facilities.

    • [DOC File]The Massachusetts Department of Education

      https://info.5y1.org/mass-dph-forms_1_a649cd.html

      Completed forms can be faxed to 617-624-5921 or mailed to the Massachusetts Tobacco Control Program, 250 Washington Street, Boston, MA 02108. How can I find out more information about the smoke-free school law in Massachusetts?

    • [DOC File]Point of Dispensing (POD) Site Plan - Template

      https://info.5y1.org/mass-dph-forms_1_3c82e9.html

      Mass prophylaxis will be provided to the population at risk within 48 hours of the decision to deploy the SNS in response to a large-scale public health emergency. In a worst-case scenario, Missouri will need to prophylax the entire population of 6,010,688 (2011 U.S. Census estimate).

    • [DOC File]Drug Incident Report Form and Protocol

      https://info.5y1.org/mass-dph-forms_1_573b9e.html

      Those occurrences that are followed by Illness, Injury, Medical Intervention and/or Death (a ‘Hotline Event’) must be reported to the Department of Public Health (DPH) and the DDS or DMH/DCF MAP Coordinator within 24 hours of discovery. To report a Hotline Event to the DPH, fill out the MOR form and fax it to DPH at (617) 753-8046

    • [DOC File]FIXED TERM TRAVEL EMPLOYEE DISCLOSURE INSTRUCTIONS

      https://info.5y1.org/mass-dph-forms_1_e6b5f5.html

      Travel Employee’s Mass. DPH License number (Text Field, up to 10 characters) The license number of the travel employee employed by your agency as issued by the Massachusetts Department of Public Health (DPH). Travel Employee’s Primary Residence (Text Field, two characters) ... Filing your FTTED and Certification Forms to CHIA.

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