TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
REGISTRAR'S NOTICE: Forms used in administering the regulation have been filed by the agency. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form with a hyperlink to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, 900 East Main Street, 11th Floor, Richmond, Virginia 23219.
Titles of Regulations: 18VAC95-20. Regulations Governing the Practice of Nursing Home Administrators.
18VAC95-30. Regulations Governing the Practice of Assisted Living Facility Administrators.
Agency Contact: Erin Barrett, Regulatory Coordinator, Department of Health Professions, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 367-4688, or email erin.barrett@dhp.virginia.gov.
FORMS (18VAC95-20)
Nursing Home Administrator Application - form available online only at https://www.license.dhp.virginia.gov/apply/
Checklist and Instructions for Nursing Home Administrator Application for Initial Licensure (rev. 7/2021)
Checklist and Instructions for Nursing Home Administrator Application by Endorsement (rev. 7/2021)
Nursing Home Administrator-in-Training Application, online form available at https://www.license.dhp.virginia.gov/apply/
Checklist and Instructions for Nursing Home Administrator-in-Training (rev. 7/2021)
Nursing Home Administrator Preceptor Application, online form available at https://www.license.dhp.virginia.gov/apply/
Checklist and Instructions for Nursing Home Administrator-in-Training (rev. 12/2022)
Nursing Home Administrator-in-Training Notice of Change of Status or Discontinuance (rev. 7/2020)
Checklist and Instructions for Nursing Home Administrator Preceptor Application (rev. 7/2021)
Preceptor Reinstatement Application (rev. 9/2022)
Checklist and Instructions for Nursing Home Administrator Reinstatement Application (rev. 7/2021)
Monthly Report of Nursing Home Administrator-in-Training (rev. 7/2020)
Nursing Home Administrator-in-Training Documentation of Completion Form (rev. 7/2020)
Proposed AIT Program Training Plan Domains of Practice (rev. 7/2020)
Continued Competency Activity and Assessment Form for Nursing Home Administrators (rev. 10/2014)
Monthly Report of Nursing Home Administrator-in-Training (rev. 12/2022)
Nursing Home Administrator-in-Training Documentation of Completion Form (rev. 12/2022)
Proposed Administrator-in-Training Program Training Plan Domains of Practice (rev. 12/2022)
Continuing Education Affidavit of Completion for Nursing Home Administrators (rev. 12/2022)
Continued Education (CE) Credit Form for Volunteer Practice (rev. 7/2020)
FORMS (18VAC95-30)
Assisted Living Facility Administrator Application for Licensure - form available online only at https://www.dhp.virginia.gov/nha/nha_forms.htm#alfa
Assisted Living Facility Administrators Education and Experience Matrix (rev. 7/2020)
Assisted Living Facility Administrator Administrator-in-Training Application - form available online at https://www.license.dhp.virginia.gov/apply/
Monthly Report of Assisted Living Facility Administrator-in-Training (rev. 7/2020)
Assisted Living Facility Administrator-in-Training Documentation of Completion Form (rev. 7/2020)
Assisted Living Facility Administrators Education and Experience Matrix (rev. 12/2022)
Monthly Report of Assisted Living Facility Administrator-in-Training (rev. 12/2022)
Assisted Living Facility Administrator-in-Training Documentation of Completion Form (rev. 12/2022)
Assisted Living Facility Administrator-in-Training Notice of Change of Status or Discontinuance (rev. 7/2020)
Assisted Living Facility Administrator Preceptor Application - form only available online at https://www.dhp.virginia.gov/nha/nha_forms.htm#alfa
Checklist and Instructions for Assisted Living Facility Administrator Preceptor Application (rev. 7/2021)
Proposed AIT Program Training Plan Domains of Practice (rev. 7/2020)
Checklist and Instructions for Assisted Living Facility Administrator Preceptor Application (rev. 9/2022)
Proposed AIT Program Training Plan Domains of Practice (rev. 12/2022)
Checklist and Instructions for Assisted Living Facility Administrator Reinstatement Application (rev. 7/2021)
Checklist and Instructions for Assisted Living Facility Administrator Preceptor Reinstatement Application (rev. 7/2021)
Checklist and Instructions for Acting Assisted Living Facility Administrator-in-Training (rev. 7/2021)
Continuing Competency Activity and Assessment Form for Assisted Living Facility Administrators (rev. 9/2010)
Continuing Education (CE) Credit Form for Volunteer Practice (eff. 2/2018)
Name/Address Change Form (rev. 3/2019)
Request for Verification of Virginia NHA or ALFA License (eff. 3/2019)
Checklist and Instructions for Assisted Living Facility Administrator-in-Training (rev. 12/2022)
Checklist and Instructions for Acting Assisted Living Facility Administrator-in-Training (rev. 12/2022)
Continuing Education Affidavit of Completion for Assisted Living Facility Administrators (rev. 12/2022)
Continuing Education (CE) Credit Form for Volunteer Practice (rev. 7/2020)
Name/Address Change Form (rev. 1/2021)
Request for Verification of Virginia Long-Term Care Administrators License (rev. 11/2019)
VA.R. Doc. No. R23-7450; Filed December 21, 2022