REGULATIONS
Vol. 37 Iss. 12 - February 01, 2021

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD OF LONG-TERM CARE ADMINISTRATORS
Chapter 20
Forms

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.

Title of Regulation: 18VAC95-20. Regulations Governing the Practice of Nursing Home Administrators.

Agency Contact: Elaine Yeatts, Agency Regulatory Coordinator, Department of Health Professions, 9960 Mayland Drive, Henrico, VA 23233, telephone (804) 367-4688, FAX (804) 527-4434, or email elaine.yeatts@dhp.virginia.gov.

FORMS (18VAC95-20)

Nursing Home Administrator Application - form available online only at https://www.license.dhp.virginia.gov/apply/

Nursing Home Administrator-in-Training Application, online form available at https://www.license.dhp.virginia.gov/apply/

Nursing Home Administrator-in-Training Notice of Change of Status or Discontinuance (rev. 3/2019)

Nursing Home Administrator-in-Training Notice of Change of Status or Discontinuance (rev. 7/2020)

Nursing Home Administrator Preceptor Application, online form available at https://www.license.dhp.virginia.gov/apply/

Checklist and Instructions for Nursing Home Administrator Reinstatement Application (rev. 3/2019)

Monthly Report of Nursing Home Administrator-in-Training (rev. 3/2019)

Nursing Home Administrator-in-Training Documentation of Completion Form (rev. 3/2019)

Proposed AIT Program Training Plan Domains of Practice (rev. 3/2019)

Checklist and Instructions for Nursing Home Administrator Reinstatement Application (rev. 7/2020)

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)

Continued Education (CE) Credit Form for Voluntary Practice (eff. 2/2018)

Continued Education (CE) Credit Form for Volunteer Practice (rev. 7/2020)

VA.R. Doc. No. R21-6618; Filed January 05, 2021