| Bernard Hudson Unit Manager, Long Term Care Unit Bureau of Long Term Care Services Long Term Care Unit, Mail Stop #33 2727 Mahan Drive Tallahassee, FL 32308 (850) 488-5861 / SC 278-5861 (850) 410-1512 / SC 210-1512 Fax |
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Oversees the state licensure and Medicare and Medicaid certification of nursing homes, intermediate care facilities for the developmentally disabled, homes for special services, transitional living facilities, and prescribed pediatric extended care centers.
Consumer Guides
- Nursing Home Guide
- Nursing Home Watchlist
- Nursing Home Guide/Watch List Posting Instructions
- Guía de Hogares de Ancianos (Spanish Nursing Guide)
Regulated Entities
- Nursing Homes (Skilled Nursing Facilities)
- Intermediate Care Facilities for the Developmentally Disabled
- Homes for Special Services
- Transitional Living Facilities
- Prescribed Pediatric Extended Care Centers
- Skilled Nursing Units (in hospitals)
Documents to download as PDF files.
Nursing Homes
- Consumer Info
- Controlling_Interest_Affidavit_for_Nursing_Homes_Coversheet
- Controlling_Interest_Affidavit_for_Nursing_Homes_A
- Controlling_Interest_Affidavit_for_Nursing_Homes_B
- Controlling_Interest_Affidavit_for_Nursing_Homes_C
- Controlling_Interest_Affidavit_for_Nursing_Homes_D - Voluntary Board Members
- Gold Seal Application
- Nursing Home Application
- Nursing_Home_Application_Instruction
- Proof of Financial Ability
- Surety_Bond
- Surety_Bond_Leased_Nursing Home
- Unconditional_Guarantee_of_Payment_Form
- Health Care Licensing Application
- Health Care Licensing Addendum
- Voluntary Board Member Affidavit
- Affidavit of Compliance --Level 2 Background Screening for Covered Employees (AHCA 3100-0007)
- Affidavit of Compliance with Background Screening Requirement (AHCA 3100-0008)
- Transfer_Discharge_Notice
- Transfer_Discharge_Fair_Hearing_Request
- Transfer_Discharge_LTC_Ombudsman_Request
- Adverse_Incident_Report_1_day
- Adverse_Incident_Report_15_days
- Attestation of Residency
- Bed Change Request Form
- Bed_Change_Request_Instructions
- Bed_Change_Room_List_Form
- Bed Vacancy Report
- Emergency Management Planning
- Facility Internet Acess Form
- Fire Incident Reporting and System Failure
- Fire Incident Reporting Form
- Monthly_Liability_Claim_Information
- Nursing Home Staffing Report Form
- Poster Order Form
- Staffing Formula Insert
- Best Practices for Compliance to Food Sanitary Conditions, January, 2004
- Best Practices for Compliance to Resident Dignity, February, 2005
- CDC Pandemic Flu Nursing Home Preparation Checklist, April, 2009
- Culture Change Information, December 4, 2008
- Determination of Nurse Staffing Adequacy in Nursing Homes, June, 2003
- Emergency Water Issues and One Week Non-Perishable Food Supply document, March 2003
- Federal 5-Day Incident Reporting, March 4, 2008
- FMQA Health Care Quality Improvement Training Info, June, 2003
- Hurricane Preparedness Notice and Form for NHs and ICFs, July, 2005
- Nursing Home Round Table Presentation-Orlando, November, 2007
- Poster Questions & Answers document May 11, 2000
- Quality Indicator Survey (QIS) Training Resource Manual, March, 2009
- Quality of Care Monitor Program: Guidelines for Falls, July, 2002
- Quality of Care Monitor Program: Guidelines for Pain, July, 2002
- Quality of Care Monitor Program: Guidelines for Pressure Ulcers, July, 2002
- Reporting Requirements for Abuse and Neglect, March 6, 2003
- SB 1202 Questions & Answers, February 15, 2002
- Statewide Provider Training, September, 2001
- Statewide Provider Training 1, September, 2002
- Statewide Provider Training 2, September, 2002
- Statewide Provider Training, November, 2003
- Statewide Provider Training, January, 2005
- Surveyor Guidance for Hot Water Temperatures, January, 2002
- Surveyor Guidance for Taking Food Temperatures, March, 2003
Applications and Forms
Transfer & Discharge Forms
Miscellaneous Forms
Provider Emergency Contact Information and Resources
Resources
Regulations
Intermediate Care Facilities for the Developmentally Disabled Persons (ICFDD)
- ICFDD Application
- Health Care Licensing Application
- Health Care Licensing Addendum
- Voluntary Board Member Affidavit
- Affidavit of Compliance --Level 2 Background Screening for Covered Employees (AHCA 3100-0007)
- Affidavit of Compliance with Background Screening Requirement (AHCA 3100-0008)
Applications and Forms
Regulations
Homes for Special Services (HHS)
- HSS Application1
- HSS Application2
- HSS Application3
- Health Care Licensing Application
- Health Care Licensing Addendum
- Voluntary Board Member Affidavit
- Affidavit of Compliance --Level 2 Background Screening for Covered Employees (AHCA 3100-0007)
- Affidavit of Compliance with Background Screening Requirement (AHCA 3100-0008)
Applications and Forms
Regulations
Transitional Living Facilities (TLF)
- TLF Application1
- TLF Application2
- Health Care Licensing Application
- Health Care Licensing Addendum
- Voluntary Board Member Affidavit
- Affidavit of Compliance --Level 2 Background Screening for Covered Employees (AHCA 3100-0007)
- Affidavit of Compliance with Background Screening Requirement (AHCA 3100-0008)
Applications and Forms
Regulations
Prescribed Pediatric Extended Care Center (PPEC)
- PPEC Application
- Health Care Licensing Application
- Health Care Licensing Addendum
- Voluntary Board Member Affidavit
- Affidavit of Compliance --Level 2 Background Screening for Covered Employees (AHCA 3100-0007)
- Affidavit of Compliance with Background Screening Requirement (AHCA 3100-0008)
Applications and Forms
Regulations
