TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD OF LONG-TERM CARE ADMINISTRATORS
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, General Assembly Building, 201 North Ninth Street, Fourth 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, Agency Regulatory Coordinator, Department of Health Professions, 9960 Mayland Drive, Suite 300, Henrico, VA 23238, telephone (804) 367-4688, or email erin.barrett@dhp.virginia.gov.
FORMS (18VAC95-20)
Checklist and Instructions for Nursing Home Administrator Application for Initial Licensure (rev. 3/2023)
Checklist and Instructions for Nursing Home Administrator Application by Endorsement (rev. 3/2023)
Nursing Home Administrator Reinstatement Application (rev. 1/2024)
Nursing Home Administrator Reinstatement Application (rev. 8/2024)
Checklist and Instructions for Nursing Home Administrator-in-Training (rev. 3/2023)
Nursing Home Administrator-in-Training Notice of Change of Status or Discontinuance (rev. 7/2020)
Nursing Home Administrator Preceptor Application (rev. 1/2024)
Preceptor Reinstatement Application (rev. 1/2024)
Preceptor Reinstatement Application (rev. 8/2024)
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)
Checklist and Instructions for Assisted Living Facility Administrator Application for Licensure (rev. 3/2023)
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 (rev. 1/2024)
Proposed AIT Program Training Plan Domains of Practice (rev. 12/2022)
Assisted Living Facility Administrator Reinstatement Application (rev. 1/2024)
Preceptor Reinstatement Application (rev. 1/2024)
Assisted Living Facility Administrator Reinstatement Application (rev. 8/2024)
Preceptor Reinstatement Application (rev. 8/2024)
Checklist and Instructions for Assisted Living Facility Administrator-in-Training (rev. 3/2023)
Checklist and Instructions for Acting Assisted Living Facility Administrator-in-Training (rev. 3/2023)
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. R25-8054; Filed August 29, 2024