Homemaker-Home Health Aide - New Jersey Division of ...

1 Training Program and Instructor personnel Record Form InformationNew Jersey Office Of the AttOrNey GeNerAlDivision of Consumer AffAirsnew Jersey BoArD of nursingRevised 6/13 Homemaker-Home Health Aide2 Table of Contents Approval . Completion/Submission .. Jersey Office of the Attorney GeneralDivision of Consumer AffairsNew Jersey Board of Nursing124 Halsey Street, Box 47030 Newark, New Jersey 07101(973) 504-6430 Homemaker-Home Health Aide Training Program InformationOverviewTo. the. public,. the. New. Nursing.( as. the. Board ).after. ,. ,.and. ,. the. the. the. the. been. the. meet.

2 The. the. ,. ,.a.. is. a. who,. a. ,. the..must ..and .the . ,. ,. :. Program Homemaker-Home Health Aide Training ..be ..care . the. ;.a. the. Health ;.an. the. New. ;.or. a. an. the. at. least. 76. hours,.to. 16. a. for. not. The. 16. a. be. a. shall. not. The. a. shall. be. the. laws. the. to. the. ,. At. the. the. Board,. be. visit. to. the. The ..deny .or ..the ..not .meet .the ..seq ., .all .initial .. history background not.

3 Issue. a. Homemaker-Home ..any .applicant,.. , .until .the . file. in. the. Investigation,. ,.or. in. the. the. ,. ,. :.(973). :.(973). applicant ( ). :.an. Certification,.a. ,.an. be. the. Board .The. the. the. for. the. * If the applicant has disclosed on the Certification and Authorization form that he or she has been convicted of a disqualifying offense, the applicant must submit evidence of rehabilitation along with the application. Failure to provide evidence of rehabilitation will result in automatic disqualification. Program coordinators should not submit an application if the applicant has been convicted of a disqualifying offense and has not attached evidence of.

4 Of .the ..the .. Board History be. days. after. the. Program Approval The. be. the. following materials are approval fee.. this. fee. [$ ].is. ,.or. a. ,. Health Aide Training Program .in. the. (a. a. bachelor nursing.( ). ). in. the. school Registration.( ).number,. ,. The. for the Homemaker-Home Health Aide Training the. ,.if. applicable.(example:. ,. ,. ). The. personnel have. an. file. with. the. of. the. Program General RequirementsThe. ,. to. be. the. ,.are. ( .9) .as .is .the ..The . (s). ( ). Board,.in. writing,.prior. to. the. date. the. ,.if.

5 There. are. any. ,. Program Completion/Submission After ..the .. ,. ; ; ;. ,. each. ,. the. Nursing .for. the. (Note:.The. );. The .completed..( .this .packet).with .each .applicant .and. : The application fee is The. be. the. the. ,. The ..the ..(for ..only) ..each ..to .the ..of .the.. The ..will .. of. the. must. be. the. school,.and. will. the. to. be. the. been. the. or. his. will. Board,. the. applicant,.in. writing,.of. any. the. applicant .to .the . : .. :.. Homemaker-Home Health aide may be assigned to patient care after the submitting agency or school has been notified of the conditionally certified Homemaker-Home Health aide s approval.

6 An aide listed as disapproved may not be assigned to patient care until notified by the Board that the application has been Sponsor Responsibilities(a). The. (b). The. the. least. two. the. school,.the. date. and. ,. the. the..name .of .the ..each ..an . ; The. for. each. be. offered:.$ ;. The. resume(s).of. the. (s)..The. instructor ,.address,.education.(the. institution,.the. type. of. diploma,.the. year. ),. (the. employer address,.the. employment,. year,. the. job. title,. and. ),. ,. (c). The ..not, ..and ..the .Board,.make.

7 (d). The ..Nursing,.at .least .two ..to .each . ,. (e). an. ,.the. any. change,.such. as. a. location,. dates,.at. least. one. to. any. such. (f). ,. ,. the. instruction,. ; ; an. ; each. include,. ,. ; ,. ;..the .student .the ..by .the . ;. Developing,. file. a. plan. for. ,. ,. ; An. ,. ,. ; (s).performance;. Program,. ,. ,. ,. :(1). ;(2). ;(3). ;.(4). ;.and(5). The. each. New. (g). The. not. use. the. Coordinator and Instructor It .is .the ..the ..assist .the ..the ..the .. both. ; ; The ..fill .in.

8 The ..order .for .the . ; ,.2 ..in .size, .of .the .applicant .and .shoulders,.taken .no .more ..to ..the .Board,.must .be ..the ..Certification; ;. the. a. ( the. : .. :. ),. the. applicant must provide evidence of rehabilitation at the time the application is the applicant does not provide evidence of rehabilitation at the time the application is submitted, the applicant will be automatically The. both. the. the. ,. ; ;. The. be. the. to. advised that official documents (for example: certificates and 9renewal forms) mailed by the Board to an inaccurate address will not be the Postal ,. ,. The ..the.

9 Will. mail. with. The ..an .applicant . ,.. ,. Content/Hour Allocation :. :. Training of transferring from another setting, Nurse Assistant ( ) or Homemaker-Home Health Aide ( ) :. (Institutional,. ) ( :. ) I. Unlicensed Assistive personnel ( ) Curriculum Content Outline HoursRecommended Content/Hour Allocation Outlines III. Long -Term Care ( ) Recommended Hour Allocation Outline Curriculum Total Course Hours -Term Care Total Module Hours Total Course Hours of transferring from another setting as with :. ,. Home Care/Hospice Recommended Hour Allocation Outline Curriculum Total Course Hours Course of transferring from another setting with Home Care :. ,. Jersey Office of the Attorney General Division of Consumer AffairsNew Jersey Board of Nursing124 Halsey Street, Box 47030 Newark, New Jersey 07101(973) names and addresses must be typed.

10 Do not complete the sections marked approved or disapproved. The New Jersey Board of Nursing will determine Health aide training Program Conditional CertifiCation eligibility listSubmitting agency or ( )..( ).Instructor ( ,. ,. ) fiscal use onlyApprovedBoard UseApplicant hereby certify that the above-listed individuals have successfully completed the Homemaker-Home Health Aide Training Program which consisted of 60 classroom hours and 16 hours of clinical hereby certify that I will ensure that the foregoing list is not altered, changed or tampered with in any way after it has been stamped and approved by the Board of further certify that I will not release this list containing confidential student information to any third party pursuant to the Buckley.