{"id":447,"date":"2025-02-25T16:28:00","date_gmt":"2025-02-25T16:28:00","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dhcq\/pubs\/"},"modified":"2025-06-10T07:30:58","modified_gmt":"2025-06-10T12:30:58","slug":"pubs","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dhcq\/pubs\/","title":{"rendered":"pubs ~  DHCQ Publications and Forms  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\r\n\r\n\r\n\r\n\r\n\r\n  <br>\r\n\r\n\r\n  \r\n\r\n\r\n  <div class=\"container\" id=\"main_header\"> \r\n\r\n\r\n    <!-- BEGIN readspeaker div -->\r\n\r\n\r\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\r\n\r\n\r\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dhcq\/pubs.html\" title=\"Listen to this page using ReadSpeaker\">\r\n\r\n\r\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\r\n\r\n\r\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\r\n\r\n\r\n      <\/a>\r\n\r\n\r\n    <\/div>\r\n\r\n\r\n    <!-- END readspeaker div -->\r\n\r\n\r\n\r\n\r\n\r\n    \r\n\r\n\r\n    \r\n\r\n\r\n    <header class=\"pull-left\">\r\n\r\n\r\n      <h1><!--[type=EDIT name=\"Page Title\"]-->PUBLICATIONS AND FORMS<!--[END]--><\/h1>\r\n\r\n\r\n    <\/header>\r\n\r\n\r\n  <\/div><br>\r\n\r\n\r\n \r\n\r\n\r\n  <div class=\"container\">\r\n\r\n\r\n    <div class=\"row\">\r\n\r\n\r\n      <div class=\"col-md-3\" id=\"leftCol\">\r\n\r\n\r\n        <div class=\"panel-group\" id=\"accordion\">\r\n\r\n\r\n          <div class=\"panel sectionmenu_panel\">\r\n\r\n\r\n            <div class=\"panel-heading\">\r\n\r\n\r\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Health Care Quality Menu<\/strong><\/a><\/p>\r\n\r\n\r\n            <\/div>\r\n\r\n\r\n\r\n\r\n\r\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\r\n\r\n\r\n              <div class=\"panel-body\" id=\"clf_nav\">\r\n\r\n\r\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\r\n    <li><a href=\"\/dhcq\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\r\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\r\n    <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\r\n    <li>\r\n      <a href=\"\/dhcq\/about.html\">About DHCQ<\/a>\r\n    <\/li>\r\n  <!--  <li>\r\n      <a href=\"\/dhcq\/sections.html\">Sections & Programs<\/a>\r\n    <\/li>-->\r\n    <li>\r\n      <a href=\"\/dhcq\/faq.html\">FAQs<\/a>\r\n    <\/li>\r\n   \r\n    <li>\r\n      <a href=\"\/dhcq\/contact.html\">Contact Information<\/a>\r\n    <\/li>\r\n         <li>\r\n           <a href=\"\/dhcq\/sitemap.html\">Sitemap<\/a>\r\n    <\/li>\r\n   \r\n  <\/ul><\/li>\r\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#ServicesMenu\"><h2>Services <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\r\n    <ul class=\"panel-collapse collapse\" id=\"ServicesMenu\">  \r\n\r\n  <li>\r\n    <a href=\"\/dhcq\/default.aspx\">Adult Abuse Registry<\/a><\/li>\r\n     \r\n        \r\n      <li>\r\n      <a href=\"\/dhcq\/ohflcmain.html\">Acute and Outpatient Care<\/a><\/li>\r\n      \r\n      <li>\r\n        <a href=\"https:\/\/backgroundcheckcenter.dhss.delaware.gov\/\">Background Check Center (BCC) <\/a>\r\n       <\/li>\r\n        <li>\r\n        <a href=\"\/dhcq\/enfinfo.html\">Enforcement Information <\/a>\r\n    <\/li>\r\n      <li>\r\n        <a href=\"\/dhcq\/licandcertmain.html\">Licensing and Certification<\/a>\r\n    <\/li>\r\n    <li>\r\n      <a href=\"\/dhcq\/cnareg.html\">Certified Nursing Assistant Registry or CNA Registry<\/a>\r\n    <\/li>\r\n    <li>\r\n      <a href=\"\/dhcq\/bgchks.html\">Criminal Background Checks and Drug Screening<\/a>\r\n    <\/li>\r\n    <li>\r\n      <a href=\"\/dhcq\/investigationsmain.html\">Investigations<\/a>\r\n    <\/li>\r\n     <\/ul><\/li>\r\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#InformationMenu\"><h2>Information <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\r\n    <ul class=\"panel-collapse collapse\" id=\"InformationMenu\">\r\n      <li>\r\n      <a href=\"\/dhcq\/emergencypreparedness.html\">Emergency Preparedness<\/a>\r\n    <\/li> \r\n\r\n           <li>\r\n      <a href=\"\/dhcq\/glossary.html\">Glossary of Terms <\/a>\r\n    <\/li> \r\n       <li>\r\n      <a href=\"\/dhcq\/licfac.html\">Licensed Facilities <\/a>\r\n    <\/li> \r\n      \r\n    <li>\r\n      <a href=\"\/dhcq\/pubs.html\">Publications &#038; Forms<\/a>\r\n    <\/li>\r\n      <li>\r\n      <a href=\"\/dhcq\/regulations.html\">Regulations<\/a>\r\n    <\/li>\r\n    <li>\r\n      <a href=\"\/dhcq\/links.html\">Related Links<\/a>\r\n    <\/li>\r\n    <li>\r\n      <a href=\"\/dhcq\/surveyreports.html\">Survey Reports<\/a>\r\n    <\/li>\r\n   \r\n\r\n      \r\n  <\/ul><\/li>\r\n<!--    <li><a id=\"SocialMenuHeader\"><h2>Connect <i class=\"fa fa-thumbs-o-up fa-fw\"><\/i><\/h2><\/a>\r\n  <ul id=\"SocialMenu\">\r\n    <li class=\"facebook\"><a href=\"https:\/\/www.facebook.com\/DEPublicHealth\" title=\"Division of Public Health Facebook Page\" target=\"_blank\"><i class=\"fa fa-facebook-square fa-lg\"><\/i> Facebook<\/a><\/li>\r\n    <li class=\"twitter\"><a href=\"https:\/\/twitter.com\/Delaware_DHSS\" title=\"Delaware Health and Social Services Twitter Account\" target=\"_blank\"><i class=\"fa fa-twitter-square fa-lg\"><\/i> Twitter<\/a><\/li>\r\n   <li class=\"googleplus\"><a href=\"#\"><i class=\"fa fa-google-plus-square fa-lg\"><\/i> Google +<\/a><\/li>\r\n    <li class=\"flickr\"><a href=\"#\"><i class=\"fa fa-flickr fa-lg\"><\/i> Flickr<\/a><\/li>\r\n    <li class=\"youtube\"><a href=\"#\"><i class=\"fa fa-youtube-square fa-lg\"><\/i> Youtube<\/a><\/li>\r\n    <li class=\"instagram\"><a href=\"#\"><i class=\"fa fa-instagram fa-lg\"><\/i> Instagram<\/a><\/li>\r\n    <li class=\"linkedin\"><a href=\"#\"><i class=\"fa fa-linkedin-square fa-lg\"><\/i> Linkedin<\/a><\/li>\r\n    <li class=\"pinterest\"><a href=\"#\"><i class=\"fa fa-pinterest-square fa-lg\"><\/i> Pinterest<\/a><\/li> \r\n  <\/ul>\r\n<\/li>  -->\r\n<\/ul>\r\n\r\n\r\n\r\n\r\n              <\/div>\r\n\r\n\r\n            <\/div>\r\n\r\n\r\n          <\/div>\r\n\r\n\r\n        <\/div><br>\r\n\r\n\r\n      <\/div>\r\n\r\n\r\n\r\n\r\n\r\n      <div class=\"col-md-9\" id=\"main_content\"> \r\n\r\n\r\n  <!--[type=HTMLEDIT name=\"Content\"]-->\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n<h2>\r\n\r\n\r\n\r\n  Publications\r\n\r\n\r\n\r\n<\/h2>\r\n\r\n\r\n\r\n<ul>\r\n\r\n\r\n\r\n  <li>Brochure &#8211; The Division has a <a href=\"\/wp-content\/uploads\/sites\/6\/dhcq\/pdf\/division_brochure_03032022.pdf\">brochure<\/a> that provides information about its services.\r\n\r\n\r\n\r\n  <\/li>\r\n\r\n\r\n\r\n  <li>Poster &#8211; The Division has a <a href=\"\/wp-content\/uploads\/sites\/6\/dhcq\/pdf\/division_poster_12092019.pdf\">poster<\/a> that gives the 24-hour, toll-free contact information for\r\n\r\n\r\n\r\n  reporting complaints\/incidents related to abuse, neglect, mistreatment, and\/or financial exploitation of residents of long term care\r\n\r\n\r\n\r\n  facilities.\r\n\r\n\r\n\r\n  <\/li>\r\n\r\n\r\n\r\n<\/ul>\r\n\r\n\r\n\r\n<h2>\r\n\r\n\r\n\r\n  Forms\r\n\r\n\r\n\r\n<\/h2>\r\n\r\n\r\n\r\n<p>\r\n\r\n\r\n\r\n  The Division has a number of forms, including those listed below. If a form is not available on the Division&#8217;s website, the phone number\r\n\r\n\r\n\r\n  to call to request a copy of the form is found with the link next to the name of the document.\r\n\r\n\r\n\r\n<\/p>\r\n\r\n\r\n\r\n<ul>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n  <li>Delaware Interagency Patient Transfer Non Emergent <a href=\"\/wp-content\/uploads\/sites\/6\/dhcq\/pdf\/Non_Emergent_Interagency-Form-B-1-06-Final_1.pdf\">Form<\/a><\/li>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n  <li>Applications for Licensure &#8211; <a href=\"contact.html\">Call the Division&#8217;s New Castle County office<\/a>.\r\n\r\n\r\n\r\n  <\/li>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n    <li>Application for CNA Reciprocity <a href=\"\/wp-content\/uploads\/sites\/6\/dhcq\/pdf\/Doc4_CNAReciprocityApplication_2022.pdf\">Reciprocity<\/a>\r\n\r\n\r\n\r\n  <\/li>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n  <li>Application for RN or LPN Graduate <a href=\"\/wp-content\/uploads\/sites\/6\/dhcq\/pdf\/Doc5_ApplicationforRNorLPNGraduate_103122.pdf\"> Nurse Aide Training Program Application <\/a>\r\n\r\n\r\n\r\n  <\/li>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n  \r\n\r\n\r\n\r\n  <li>\r\n\r\n\r\n\r\n    <a href=\"\/wp-content\/uploads\/sites\/6\/dhcq\/pdf\/dltcrp_cmp_request_form_final_03122018.pdf\">CMP Request Form: Long Term Care Residents&#8217; Trust Fund<\/a>. This form should\r\n\r\n\r\n\r\n    be completed following the Instructions to Request Approval for\r\n\r\n\r\n\r\n    Use of Civil Money Penalty Funds for Certified Nursing Homes from the Long Term Care Residents&#8217; Trust Fund.\r\n\r\n\r\n\r\n  <\/li>\r\n\r\n\r\n\r\n  <li>\r\n\r\n\r\n\r\n    <a href=\"http:\/\/delcode.delaware.gov\/title12\/c049a\/sc03\/index.shtml\">Delaware Durable Personal Power of Attorney.<\/a>\r\n\r\n\r\n\r\n  <\/li>\r\n\r\n\r\n\r\n  <li>\r\n\r\n\r\n\r\n    <a href=\"\/wp-content\/uploads\/sites\/6\/dhcq\/pdf\/dltcrp_uai_revision_01232008_final_a.pdf\">Uniform Assessment instrument for Assisted Living Facilities<\/a>,\r\n\r\n\r\n\r\n    Revised January 23, 2008.\r\n\r\n\r\n\r\n  <\/li>\r\n\r\n\r\n\r\n<\/ul>\r\n\r\n\r\n\r\n  <!--[END]-->\r\n\r\n\r\n  \r\n\r\n\r\n      <\/div>\r\n\r\n\r\n    <\/div>\r\n\r\n\r\n  <\/div><!-- \/container -->\r\n\r\n\r\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Listen PUBLICATIONS AND FORMS Health Care Quality Menu Home About About DHCQ FAQs Contact Information Sitemap Services Adult Abuse Registry Acute and Outpatient Care Background Check Center (BCC) Enforcement Information Licensing and Certification Certified Nursing Assistant Registry or CNA Registry Criminal Background Checks and Drug Screening Investigations Information Emergency Preparedness Glossary of Terms Licensed Facilities [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-447","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dhcq\/wp-json\/wp\/v2\/pages\/447","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dhcq\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dhcq\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dhcq\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dhcq\/wp-json\/wp\/v2\/comments?post=447"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dhcq\/wp-json\/wp\/v2\/pages\/447\/revisions"}],"predecessor-version":[{"id":791,"href":"https:\/\/dhss.delaware.gov\/dhcq\/wp-json\/wp\/v2\/pages\/447\/revisions\/791"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dhcq\/wp-json\/wp\/v2\/media?parent=447"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}