Cdph 278B Form PDF Details

On July 1, 2017 a new law went into effect in the state of California regarding how individuals must inform their sexual partners of any potential exposure to HIV. This law, known as Cdph 278B, requires that individuals disclose their HIV status to any and all sexual partners, regardless of whether or not they have symptoms of the virus. Failure to comply with this new law can result in criminal penalties. This new law is an important step in preventing the spread of HIV in California, and it is essential that all individuals comply with its requirements. If you are living with HIV or know someone who is, it is important to understand how this new law works and what steps you need to take to ensure compliance. For more information on C

QuestionAnswer
Form NameCdph 278B Form
Form Length2 pages
Fillable?Yes
Fillable fields82
Avg. time to fill out16 min 58 sec
Other names278b, cdph 278c, cdph 278b, cdph 278a and 278b

Form Preview Example

State of California-Health and Human Services Agency

California Department of Public Health (CDPH)

 

Licensing and Certification Program (L&C)

 

Aide and Technician Certification Section (ATCS)

 

MS 3301

 

P.O. Box 997416

 

Sacramento, CA 95899-7416

 

(916) 327-2445 FAX (916) 324-0901

IN-SERVICE TRAINING PROGRAM

(To be completed by ALL skilled nursing and intermediate care facilities)

 

 

See page two for instructions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Facility name and address:

Provider identification training number:

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone: (

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All Parties Must Sign

 

 

Required Signatures

 

 

Administrator

Signature

Director of Nursing

Signature

Director of Staff Development

Signature

Each nursing facility shall provide 24 hours of in-service training annually which shall be accessible to all certified nurse assistants employed by the facility. The content of the in-service training program shall be an enhancement to the basic training program, consistent with the needs of the facility residents as determined by facility staff and shall also address areas wherein the facility received deficiencies following the last licensing survey. Include 5 hours of dementia specific training per year.

Programs shall be reviewed for reapproval every two years.

Please list the in-service topics below, totaling at least 24 hours: Include time allocated for each topic (minimum 1 hour).

TOPIC

TIME

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

Total Hours

TOPIC

TIME

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

Total Hours

California Department of Public Health Use Only

Approved By:

Program Consultant

Date

CDPH 278B (06/11) This form is available on our website at: www.cdph.ca.gov

Page 1 of 2

1.Submit two lesson plans (from two different topics listed) which shall include the following:

a.Student behavioral objectives.

b.Descriptive topic content (technique, method, procedures).

c.Method of teaching.

d.Method of evaluation that indicates that learning has occurred.

2.Submit your proposed three-month schedule calendar of in-service training programs.

3.Indicate your method for including all three shifts for in-service training.

I certify that:

1.When in-service videos and/or tapes are utilized, the instructor is present for discussion and/or demonstration.

2.All records of in-service training programs and attendance records are kept on file for a period of four years.

3.Home/independent study is not done.

Director of Staff Development signature

Date

Before sending to CDPH for review and approval, check the following:

Did you get all required signatures?

Did you include two lesson plans?

Did you include three-month schedule?

Did you indicate how three shifts are in-serviced?

Did you fill in all information on this form?

Original signatures must be submitted. A faxed or scanned copy will not be accepted. Keep copies for your records.

CDPH 278B (06/11) This form is available on our website at: www.cdph.ca.gov

Page 2 of 2

How to Edit Cdph 278B Form Online for Free

Making use of the online tool for PDF editing by FormsPal, it is possible to complete or alter california 278b form here. The tool is constantly upgraded by our team, getting additional functions and growing to be greater. Here's what you'd have to do to get started:

Step 1: Hit the orange "Get Form" button above. It'll open up our tool so you can start filling in your form.

Step 2: With this handy PDF editing tool, it's possible to do more than just fill in blank form fields. Try all of the features and make your forms look perfect with customized textual content added, or optimize the original input to excellence - all supported by an ability to insert your own images and sign it off.

This PDF doc will involve some specific details; to guarantee accuracy and reliability, be sure to take heed of the next tips:

1. When filling in the california 278b form, make sure to include all of the needed blank fields within the relevant area. It will help hasten the process, allowing for your details to be processed promptly and correctly.

Tips to fill in form 278a stage 1

2. The next part is usually to submit the next few fields: TOPIC, TIME, TOPIC, TIME, Approved By, Total Hours, Total Hours, and California Department of Public.

Total Hours, Total Hours, and TIME inside form 278a

3. This next part should be fairly simple, Director of Staff Development, Date, Before sending to CDPH for review, Did you get all required signatures, Did you include two lesson plans, Did you include threemonth schedule, Did you indicate how three shifts, Did you fill in all information on, and Original signatures must be - all these blanks needs to be filled out here.

Filling out section 3 of form 278a

Many people often get some things wrong when filling in Did you include two lesson plans in this part. Remember to go over everything you enter right here.

Step 3: You should make sure the information is correct and click "Done" to finish the task. Sign up with us right now and easily obtain california 278b form, available for download. All adjustments you make are preserved , which means you can change the document later on if required. FormsPal is focused on the confidentiality of all our users; we make certain that all personal information used in our tool is protected.