HFEL-6, Resident Care Staffing Report
New Jersey Department of Health
RESIDENT CARE STAFFING REPORT
|REPORT FOR | |
| |(Date) |
NOTICE TO CONSUMER
Section 941 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) and N.J.S.A. 26:2H-5f et seq. requires skilled nursing facilities and nursing facilities to post daily for each shift the number of licensed and unlicensed nursing staff directly responsible for resident care in the facility. This information shall be displayed in a place where residents and the general public can easily view it.
|Name of Nursing Home |
| |
|Shift |Current Resident |Staff Category |Actual Hours |Number |Staff to Resident Ratio |
| |Census | |Worked |of Staff Scheduled | |
| | |Registered Nurses (RN) | | RNs |1 RN: ___.___ Residents |
| | |Licensed Practical Nurses (LPN) | | LPNs |1 LPN: ___.___ Residents |
| | |Certified Nurse Aides (CNA) | | CNAs |1 CNA: ___.___ Residents |
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