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29.12.2020

nj ddd medication administration record

Dodano do: jennifer allen obituary

Initial Uniform Application for Services to Individuals 21 and Under with Developmental Disabilities: pdf (33k) doc (61k) FHS-18: . 13110 0 obj <>stream Date: 2/15/2023. 0000001465 00000 n endobj Affirmative Action Survey (optional) 12. 0000018364 00000 n Date of Report . Duty Area 8: Organize to Administer Medications to Residents 77-80 . Download the form We Are Proud of Letting You Edit Medication Administration Record In the Most Efficient Way Take a Look At Our Best PDF Editor for Medication Administration Record Download the form People Also Search For !CtP]W?z; The State of NJ site may contain optional links, information, services and/or content from other websites operated by third parties that are provided as a convenience, such as Google Translate. 0000001710 00000 n 0000003930 00000 n Authorization for Automatic Payments & Deposits 13. ; 4. 6iD_, |uZ^ty;!Y,}{C/h> PK ! Developmental Disabilities Administrative Act [20 ILCS 1705/15.4]. 0000001444 00000 n dY?hG&sEFI, Z!r^tv *GP2|QY#'GlUnzvvRf:*EnxDtN d"a G/O)CFIc@hANwqK.DRtO)~>R>>^pJo3\?%_0'q0~LQo>E/"pO$Kc4h#P|CXvy3 xi7 2j Application and Consent for Sterilization of Pets, Payment Voucher / Veterinarian Reimbursement, Animal Population Control Program Proxy Authorization, Rehabilitative Hospital and Special Hospital subject to a $10 Adjusted Admission Assessment, Asbestos Management Plan, Room/Functional Space Inspection, Request for Bacterial or Viral Culture or Parasite Identification, Application For Certificate of Approval To Operate a Youth Camp, Application For Certificate of Approval To Operate a Single Sport Youth Camp, Annual Accident Report Youth Camp Safety Act, Youth Camp Self-Inspection Report (for Youth Camp Operators), Youth Camp Safety Detailed Data Sheet (for Local Health Inspectors), Youth Camp Safety Detailed Data Sheet (for Youth Camp Operators), Certification for the Replacement of Main Drain Covers in Pool/Spa, Pediatric HIV Confidential Case Report Form, Typhoid And Paratyphoid Fever Surveillance Report, Cholera And Other Vibrio Illness Surveillance Report, Multisystem Inflammatory Syndrome Associated with COVID-19: Case Report Form, For Reporting Reportable Communicable Diseases, Patient Symptoms Line Listing (Respiratory Tract Infection), Patient Symptoms Line Listing (Gastrointestinal Infection). Application for Approval to Operate a Body Art Establishment (Permanent) For use by Local Health Department Officials only. 0000007895 00000 n Kl],q,[-?A%v fw{XJMqxh iugdnNuSscWJ 1 0 obj HCANJ | New Jersey (NJ) NursingCenter and Assisted Living Providers Lt. Medication Administration Record (MAR) Form D.401. Duty Area 6: Medication Administration Records (MARs) and other forms 71-78 Duty Area 7: Demonstrate the Five Rights of Medication Administration 79-86 . 0000007916 00000 n For more information and to review Training Reimbursement Payment FAQ, please visit PPL's NJ DDD Program webpage at . 0000004971 00000 n 0000002840 00000 n Please select a role from drop-down to login. endstream endobj 76 0 obj <. 0000075899 00000 n Medication 20A Prescription Medication 20B PRN (as needed) Prescription Medication 20C PRN Over the Counter (OTC) Medication 20D Medication Storage 20E Medication Administration 21. N _rels/.rels ( JAa}7 Provider Search Filter The Division of Developmental Disabilities Quality Improvement Jill Lewis, RN Performance Improvement Nurse Division of Developmental Disabilities Jlewis3@azdes.gov. 11988, effective September 13, 1999, for a {0W\93*-ajwB}2M1C:4\#{p3gzQ1.vg6~dA<4?A;@R^gi7@|O1yZyG$#l]L< R95~NBUWb8)'j Hn$1aOaS\.,&,$rEc,h>uJWJ!Uj2Ky 3e5bFe3YO1Q"T7k!lUb. trailer << /Size 46 /Info 4 0 R /Root 7 0 R /Prev 77665 /ID[<0c226b5500007d2f0ee1517cbce23df1>] >> startxref 0 %%EOF 7 0 obj << /Type /Catalog /Pages 3 0 R /Metadata 5 0 R /PageLabels 2 0 R >> endobj 44 0 obj << /S 36 /L 133 /Filter /FlateDecode /Length 45 0 R >> stream Add you name and contact information to New Jersey's Special Needs Registry for Disasters. 0 0000001853 00000 n Microsoft Word - F9 Medication Administration Record.doc 0000005111 00000 n endobj Augusta, NJ 07822 Subject: Medication Departments Affected: All Programs Effective Date: 3/1/19 Replaces Policy: 10/9/87; 2/23/90; 4/15/92 . DDD Provider Agreement - (DDD-PA 01-03-2019) 8. 0000009100 00000 n The CDS training module has been updated with NJ specific content and annotations to ensure staff are familiar with NJ policies and regulations as noted in the classroom training. R-Refused by Individual 3. . j)LdrJr+ew>ni\9)>9e3w]xW`C g0^:LhxG/KG~ pWO:+89MUozeu|:xbf}\Wy3CiSjr4~sNgW endstream endobj 21 0 obj << /Type /FontDescriptor /Ascent 905 /CapHeight 718 /Descent -211 /Flags 32 /FontBBox [ -665 -325 2028 1006 ] /FontName /OIIMPL+Arial /ItalicAngle 0 /StemV 94 /FontFile2 41 0 R >> endobj 22 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 146 /Widths [ 278 0 0 0 0 0 0 0 0 0 0 0 278 333 278 0 556 556 556 556 556 556 556 556 556 556 278 0 0 0 0 556 0 667 0 722 722 667 0 778 722 278 0 0 556 833 722 778 667 0 722 667 611 0 667 0 667 667 0 0 0 0 0 0 0 556 556 500 556 556 278 556 556 222 0 0 222 833 556 556 556 556 333 500 278 556 500 722 0 500 500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 222 ] /Encoding /WinAnsiEncoding /BaseFont /OIIMPL+Arial /FontDescriptor 21 0 R >> endobj 23 0 obj 745 endobj 24 0 obj << /Filter /FlateDecode /Length 23 0 R >> stream Any changes or additional submission processes will be posted to the Department of Health website. You may filter your search results further by services, provider location, location type, etc., or use a combination of searches and filters to browse provider options. 0000009703 00000 n Medication Dispensing Record (Updated October 15th, 2021) pdf (993k) . for electronic AND hand-written completion. 0000003054 00000 n 3. To learn more about using our criminal records searches and other background check services, please contact Corra Group at 310-524-9800 or email us: [email protected] D. Explore the safest neighborhoods in the U. 0000004312 00000 n The user is on notice that neither the State of NJ site nor its operators review any of the services, information and/or content from anything that may be linked to the State of NJ site for any reason. fillable PDF form posted, Word document no longer available. Medication Administration Medication Administration Medication administration training and certification developed by DODD authorizes caregivers to perform a variety of tasks for people with many different medical conditions. Employee locked box and secured key. org provides free access to printable PDF Form MI-1040 is the most common individual income tax return filed for Michigan State residents. 0000003946 00000 n % fillable PDF form - use Adobe Reader (click to download Reader), Instructions for Completing the PHSS-5 Payment Voucher, Guidelines (Guia), (English/espaol) (REG-D34), Instructions for Completion of TB-70 Form, Instructions for Submission of Specimens (packaging and transport), Instructions for State-Sponsored Municipal Rabies Vaccination Clinics, Policies and Guidelines for Animal Rabies Vaccination. 0000002037 00000 n 'Od>o.=h=2QfCdpu4Y-QW FbMPl3#Mq43 w{hcn3d;/?d,lO$F~8!z0hJ'.'^}\_]wZw:R7xt^u\6Yw|>XV_\8M!}RcO8)^Ao(H_.yc{JEQS0 d_co"c x0{_%nf#>6hGv8@I>uf>>aXmo?E1\0- ds-h.@q}a^_#zx-ZBB2UYauKD|B t"}{J>Y4WMxA$|j[TcoC+-^x0M :"8xqrdV;!l. Contact providers directly for more details about whether they currently provide services in your area and if they are a suitable match for you or your family member. 0000005868 00000 n DDD Day Program Manual 11/06 Forms: Form F(9) MEDICATION RECORD (must be completed in ink) NAME INITIALS Individual's Name: 1. Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017, [3] [4] [5] as well as paying for half of all U.S. births in 2019. A medication administration record to document any medications given as instructed in rule 65G-7.008, F.A.C. endstream endobj startxref Hb``Pc``, p@i 2. ), Catastrophic Illness in Children Relief Fund (CICRF), Commission for the Blind & Visually Impaired (CBVI), Division of the Deaf & Hard of Hearing (DDHH), Division of Developmental Disabilities (DDD), Division of Medical Assistance & Health Services (DMAHS), Division of Mental Health and Addiction Services (DMHAS), Office for Prevention of Developmental Disabilities, Office of Program Integrity & Accountability, Public Advisory Boards, Commissions & Councils, Memo from Deputy Commissioner Apgar regarding rescinding DC #33, Assistant Commissioner Ritchey Letter regarding Division Circular #34, Behavior Support Plans, DEVELOPMENT AND PROMULGATION OF DIVISION CIRCULARS AND QUALITY ENHANCEMENT PROCEDURES, CONTRIBUTION FOR CARE AND MAINTENANCE REQUIREMENTS, MANAGEMENT OF FUNDS WHERE DDD OR THE PROVIDER IS REPRESENTATIVE PAYEE FOR AN INDIVIDUAL'S BENEFITS, PRINCIPLES AND GOAL OF THE DIVISION OF DEVELOPMENT DISABILITIES, GUARDIANSHIP: NEED, APPOINTMENT, CONTINUITY, COMMUNITY CARE WAIVER WAITING LIST PROCEDURES, COMPLAINTS FILED UNDER THE AMERICANS WITH DISABILITIES ACT (ADA), COMPLAINT INVESTIGATIONS IN COMMUNITY PROGRAMS, DEFENSIVE TECHNIQUES AND PERSONAL CONTROL TECHNIQUES, MECHANICAL RESTRAINT AND SAFEGUARDING EQUIPMENT, REFERRALS FOR PLACEMENT FROM DEVELOPMENTAL CENTERS AND TRANSFERS TO COMMUNITY LIVING ARRANGEMENTS, REPRESENTATION, INDEMNIFICATION, AND EXPUNGEMENT OF ARREST RECORDS OF DIVISION EMPLOYEES AND FORWARDING OF LEGAL PAPERS, RECORDS CONFIDENTIALITY AND ACCESS TO CLIENT, DIVISIONAND PROVIDER RECORDS, AUTHORIZATION FOR EMERGENCY MEDICAL, SURGICAL, PSYCHIATRIC OR DENTAL TREATMENT, TRANSFER OR DISCHARGE FROM CONTRACTED PROVIDER, DEATH AND FUNERAL ARRANGEMENTS OF A PERSON RECEIVING SERVICE, PAYMENTS TO OPERATORS OF COMMUNITY CARE RESIDENCES (, SKILL LEVEL DETERMINATION AND COMPENSATION, PLACEMENTS FROM COMMUNITY SERVICES INTO PSYCHIATRIC HOSPITALS, COMMUNITY SERVICES SYSTEM OF CASE MANAGEMENT, HIPAA-ADMINISTRATIVE POLICIES AND PROCEDURES, HIPAA-USES AND DISCLOSURES POLICIES AND PROCEDURES, HIPAA-CLIENT RIGHTS POLICIES AND PROCEDURES, Federal Deficit Reduction Act of 2005, Section 6032 - Policy on Fraud, Waste and Abuse, Federal Deficit Reduction Act of 2005, Section 6032 - Policy on Compliance. Staff persons may participate in a . Course - Medication Administration Record (MAR) About the Course This course teaches users how to record medications using Therap's Medication Administration Record . (fFv~V%446_s95O\+}CQd1e(2)BBDb6U)t!o.8 Gc>\L`hQlL`:pv*WmeG&FI$'z?bgX/("JR&ImgbjUi0uD(:^h2*8w!Q$$ kyDX>(un^,^.}4d.=\|qj2,$2BDCqmx82u%3]%R8K1bkV32;yD4+x]o?^ls!6xMA\8673`_t)\{ZFxzQiW !qDEfw/9vz@xZ=exH^Z!CNDZ1>(JstT8_F96ef written medication administration records 4. Doctors order form (Hold Harmless- signed by physician, parent) (Permission To Retain Form-signed by the physician, parent, and student) The medication in the original pharmacy container. 0000005208 00000 n Contact us 732.246.2525 x38 or x24 or at thefamilyinstitute@arcnj.org. Notice to Enrollee 11. Stokes Instructions for Completing the Record of Work Search You can Uia 6347 Michigan In addition to completing Form UIA 6347, you will also be asked to provide your:. PK ! Hemolytic Uremic Syndrome (Postdiarrheal) Report, Epidemiology Surveillance Record (Hospital-Based Laboratory), Report of Known or Suspected Avian Chlamydiosis (Psittacosis), Outbreak Report for Long Term Care and Other Institutions, Outbreak Report for Child Care, School and Camp Settings, Child Care Center - DOH Subsequent Notification, Statement of Education and Experience Requirements, Checklist for Public Recreational Bathing Facilities, Notification of Non-Friable Asbestos Work Activities, Notification of Non-Friable Asbestos Work Activities Related to Superstorm Sandy, Contractor Information for Non-Friable Asbestos Work Activities, Body Art or Ear-Piercing Establishment Report of Infection or Injury, Physician Report Form (Non-Hospital Source), Application for Cottage Food Operator Permit, Child Health Conference - Health Assessment (Infancy: 2-6 Weeks), Child Health Conference - Health Assessment (Infancy: 2 Months), Child Health Conference - Health Assessment (Infancy: 4 Months), Child Health Conference - Health Assessment (Infancy: 6 Months), Child Health Conference - Health Assessment (Infancy: 9 Months), Child Health Conference - Health Assessment (Infancy: 12 Months), Child Health Conference - Health Assessment (Childhood: 15 Months), Child Health Conference - Health Assessment (Childhood: 18 Months), Child Health Conference - Health Assessment (Childhood: 2 Years), Child Health Conference - Health Assessment (Childhood: 3 Years), Child Health Conference - Health Assessment (Childhood: 4 Years), Child Health Conference - Health Assessment (Childhood: 5 Years), Child Health Conference - Health Assessment (Childhood: 6 Years), Child Health Conference - Health Assessment (Childhood: 7 Years), Child Health Conference - Health Assessment (Childhood: 8 Years), Child Health Conference - Health Assessment (Childhood: 9 Years), Child Health Conference - Health Assessment (Childhood: 10-12 Yrs), Child Health Conference - Health Assessment (Childhood: 13-15 Yrs), Child Health Conference - Health Assessment (Childhood: 16-20 Yrs), Child Health Services Quarterly Summary Report, Care Plan for Children with Special Health Needs, Organic and Inorganic Chemistry Sample Submittal, Application for a Clinical Laboratory License, Blood Bank Annual Statistics (Out of Hospital and Emergency Only Transfusion Facilities), Disclosure of Ownership and Control Interest, Blood Bank Annual Statistics (Umbilical Cord Blood Facilities), Laboratory Personnel Qualification Appraisal, Blood Bank Personnel Qualification Appraisal, Brokers and Reagent Manufactureres - Annual Statistical Data, Request for Funding from Civil Monetary Penalties, Clinical Laboratory Improvement Amendments (CLIA) Application for Certification, Full Review Certificate of Need Application for Long Term Care Facilities: General Long Term Care Beds; Specialized Long Term Care Beds, Application for Certificate of Need for Hospital-Related Projects, Application for Certificate of Need for Designation as a Perinatal Facility, Project Application for an Adult Day Health Services Facility, Application for New or Amended Acute Care Facility License, Project Application for Expansion Slots at a Licensed Adult Day Health Services Facility, Health Care Facility Inquiry Regarding Health Care Professional (HFEL-9) (updated August 10,2017), Annual Report of Megavoltage Radiation Unit, Surgical Practice Application for Registration, Renewal, Relocation, Transfer of Ownership (Formerly HFEL-8), Certificate of Need Application-Expedited Review for Facilities and Services Identified at NJAC 8:33-5.1(a), HIV Confidential Consent Form (Serology) (spanish), HIV Consent (Rapid Testing) - Confidential and Anonymous Testing, HIV Consent (Rapid Testing) (Confidential and Anonymous) (spanish), HIV Consent (Rapid Testing) (Confidential and Anonymous) (Creole), HIV Consent (Rapid Testing) - Confidential Testing Only, HIV Consent (Rapid Testing) (Confidential Only) (spanish), HIV Consent (Rapid Testing) (Confidential Only) (Creole), Application for Eligibility for the HIV Home Care Program, Pediatric HIV/AIDS Confidential Case Report, Renewal Application for Lead Training Agency Certification, Initial Application for Asbestos Training Agency Certification, Renewal Application for Asbestos Training Agency Certification, Application for Reciprocal Asbestos Accreditation, Application for Approval as a NJ Asbestos Course Instructor, Application for Approval as a NJ Lead Course Instructor/Training Manager, Application for Lead Permit Worker-Housing and Public Buildings, Application for Lead Permit Supervisor, Housing and Public Buildings, Application for Lead Permit Inspector/Risk Assessor, Application for Lead Permit Planner/Project Designer, Application for Lead Permit Worker, Commercial Buildings and Superstructure, Application for Lead Permit Supervisor, Commercial Buildings and Superstructures, Initial Application for Lead Training Agency Certification, Application for Replacement of Lead Permit. PLEASE ISSUE PRESCRIPTIONS FOR MEDICATION, DIET, ADAPTIVE EQUIPMENT, PROCEDURES AND THERAPIES. hb`````f`a`2f`@ +sL Xdjz%$M xS8/;klw Ig10@b`<3n9/}k(@ g startxref H1Fa>WaZdqXUJz Xi[`Dy2lGmdnbv5? jF-ny8oO?[Z5z~au^?~uc SxmYwn#>9Vki?X82m . 0000069017 00000 n Providers are responsible for updating DDD with their current information. www.publicpartnerships.com. Employee obtained key and opened box. 0000002533 00000 n Call NJPIES Call Center for medical information related to COVID. In the future, additional features will be available, including the ability to search by radius around a zip code, catchment area and by keywords. Adverse Reactions dpcC0Hj=]bTj[+e uLgJ3!hTT/YKg91I=Q>U8plo' qQ,Nj@#7.l>. 7. 0000004350 00000 n Application for Temporary Marketing Permit: Renewal Application to Operate a Bulk Tank Unit/Milk Plant, Mental Health Professional Compliance Form, Request for Medication To End My Life in a Humane and Dignified Manner, Attestation for Compliance with Wavier Requirements to Provide Medications for the Treatment of Substance Use Disorder (MH), Faithful Families Eating Smart and Moving More, Application for Approval of a Certified Medication Aide Training and Competency Evaluation Program (MATCEP) in Assisted Living Residences / Assisted Living Programs / Comprehensive Personal Care Homes, Addendum: CMA Training - List of Course Attendees, Application for Nursing Home Administrator License, Sponsor Application for Continuing Education Program Approval for Licensed Nursing Home Administrators, Application for Approval of Administrative Intern Program, Certification of Program Completion for Nursing Home Administrative Intern Program, Institutional Approval of Intramural Research, Agreement for Ethical Conduct of Human Subjects Research, Agreement for Ethical Conduct of Human Subjects Research (Federal Employees), Notice of Claim of Exemption of Tobacco Retail Establishment, Application for Registration of Exempt Cigar Bar or Lounge, Application for Renewal of Registration of Exempt Cigar Bar or Lounge, NJ Smoke Free Air Act / Anonymous Request for Investigation, Public Employees Occupational Safety and Health (PEOSH) Unit Request for On-Site Consultation, EMS Respiratory Protection Program Evaluation Questionnaire, PEOSH Respirator Medical Evaluation Questionnaire, Firefighter Respirator Medical Evaluation Questionnaire, Documentation of Medical Evaluation for Respirator Use, Occupational and Environmental Disease, Injury, or Poisoning Report by Health Care Provider, Firefighter SCBA After Use/Daily Inspection Checklist, Clinical Laboratory Report of Elevated Levels of Heavy Metals:Lead: In Adults (Greater than 16 Years of Age)Arsenic, Cadmium, Mercury: In Persons of Any Age, PEOSH Hazard Communication Standard, Documentation of Training, Sample Letter for Requesting Safety Data Sheets (SDS's), Worker and Community Right to Know Act / Employer Outreach Survey, Quarterly Report of RTK County Lead Agencies, Public Employees Occupational Safety and Health (PEOSH) Unit Complaint, J-1 Visa Waiver / State Conrad 30 Program - Physician-Primary Care Survey, Initial/Biannual Service Report, J-1 Visa Waiver / State Conrad 30 Program - Application for New Jersey, Attachment A: Current Medical Staffing at Practice Site, Attachment B: Health Care Resources Inventory, Attachment C: Facility Current Sliding Fee Scale, Attachment D: J-1 Physician Visa Waiver / State Conrad 30 Program - Statements, Section 4-1, Health Facility's J-1 Visa Waiver / State Conrad 30 Program - Agreement, Section 4-2, Physician J-1 Visa Waiver / State Conrad 30 Program - Affidavit and Agreement, Section 5, J-1 Visa Waiver Required Application Enclosures, American Cancer Society (ACS) Monthly Activity Report, Mom's Quit Connection (MQC) Monthly Activity Report, Requisition for Printing and Graphic Design, Application for Tanning Facilities Registration, Signature Page, Acknowledging Receipt of Grant Agreement for Special Health Projects, Confidential Medical Waste Exposure Report, Questionnaire to Assess Your Exposure Risk for Lead and Mercury (Quicksilver), Radioanalytical Services Sample Submittal, Quarterly Report of Domestic Partnerships Registered, Delegation of Authority to Receive Certified Copy of Vital Record (Birth/Death), Delegation of Authority to Receive Certified Copy, Report of No Births, Marriages, Civil Unions, Domestic Partnerships or Fetal Deaths, Application for a Certified Copy of a "No Record of Marriage" Statement (English/Spanish), Certified Municipal Registrar Recertification Course Tracking Log, Application to Amend a New Jersey Vital Record /, Authorization for Release of Cause of Death, APLICACIN PARA COPIAS CERTIFICADAS CERTIFICACIONES DE REGISTROS CIVILES, APLICACIN POR UNA COPIA CERTIFICADA CERTIFICACIONES DE UN REGISTRO CIVIL, Correcting a Birth Record for Child Whose Natural Parents Married After Its Birth. You may also contact /X word/document.xml}nH/rg%e%&p\5h9)j5`a}~DR:DwY")FOc48 A l]HI0Ar7K{Q0N%b_&SNWW((~4B?z*+24#?Hzg/--c#/M>DO'xKpxlf/-:t9;$dFQ.eWPxC! Individual Records 28. Behavior Management 23. 0000004088 00000 n Visit: covid19.nj.gov Call NJPIES Call Center for medical information related to COVID: 800-962-1253 erdot; xref Agreement of Understanding 14. Compensation 26. 0000002762 00000 n Y$M6R};gK~#w0G]VrsN}y6:n$RgWl{OW?f\)*UT)TzhXuK. ?`:`tOH/_MCJXX;LMV2~=c$ 3(p\w}3vA\$e 05eBQZL 8l/;dz;(Twkmc.>~i7/i !$F?K$+`/G>S%l0UjjPkkkd.59=d]nm0 93y$A\@sZ*RnebmMKcju VZK2ck:F80 WzRejh hbbd```b``:"IMZ `= EfI.20,~," IQ T&`$ 0 #4 stream NEW! [.-gR\O54 >G7Nl6ebus *b]]G5;BT4R. Self-Directed Home Care for: State Programs. 0000002067 00000 n Over-the-counter medications may be purchased in bulk supply as long as client-specific physician orders are in place in the client record. 0000005360 00000 n 6. fao.b*lIrj),l0%b 0000001144 00000 n Medication Administration Record (MAR) Published User Guides Support RSS Feed. 2962 0 obj<>stream 0000000693 00000 n 0000005319 00000 n 0000003968 00000 n PRESENTATION OUTLINE PART 1 MEDICATION PASS . 6o.m.=GZh&v#x[S}p_^wfobMimSMo5\Xu#. %%EOF Asbestos Training Course Proposal Checklist, Survey Report for Mobility Assistance Vehicles (Sample), Survey Report for Ambulance (Basic Life Support) (Sample), Survey Report for Ambulance (Advanced Life Support) (Non-Transport) (Sample), Survey Report for Ambulance (Advanced Life Support) (Transport) (Sample), Quarterly Report of Specialty Care Transport Units, Application for Accreditation - Emergency Medical Technician Education Program, Application for Certification as an Emergency Medical Technician-Basic Instructor, Emergency Medical Technician Training Fund Final Reimbursement Report, Emergency Medical Technician (EMT) Training Fund Certificate of Eligibility for EMT Education, EMT & Paramedic Clinician Reciprocity Application Verification of EMT & Paramedic Education and Licensure, New Jersey Medical Reserve Corps User Enrollment Request, Registration of Drug or Medical Device Manufacturing or Wholesale Drug or Medical Device Business, Bulk and Bottled Water Establishment Application, Initial Application for License to Operate a Refrigerated Warehouse and/or Locker Plant, Initial Application for License to Operate a Non-Alcoholic Beverage Manufacturing Plant, Application for Certificate of Free Sale (CFS), Renewal or Discontinuation Application to Operate a Wholesale Drug or Medical Device Business, Application for Permit to Handle Nitrous Oxide, Renewal Application to Operate a Refrigerated Warehouse-Locker Plant, Initial Application for License to Operate a Wholesale Food-Cosmetic Establishment, Retail Food Inspection Report (Local Health Departments), Risk-Based Inspection Report (Local Health Departments), Renewal Application to Operate a Non-Alcoholic Beverage and/or Bottling Plant, Renewal Application to Operate a Wholesale Food/Cosmetic Establishment, Renewal Application for Certification to Sell Bottled Water or Bulk Water, Application for Certification to Handle Oysters, Clams or Mussels, Individualized Family Service Plan (IFSP), Initial Uniform Application for Services to Individuals 21 and Under with Developmental Disabilities, Withdrawal of Dispute Resolution Request (formerly titled "Withdrawal of Complaint"), Family Cost Participation Application for Income Adjustment, Family Cost Participation Income Documentation, Family Cost Participation - 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