Hospital Patient Care Staffing
|
| Form # |
Title |
PDF/WORD |
Instruction/ Comments |
| HCQ-3 |
Daily Patient Care Staffing: Inpatient Units |
pdf 17k
doc 54k |
Instructions for Completing the HCQ-3 Form
pdf 13k
doc 25k
|
| HCQ-3A |
Daily Patient Care Staffing - Inpatient (Spanish) |
pdf 19k
doc 58k |
Instructions for Completing the HCQ-3a Form
pdf 14k
doc 27k
|
| HCQ-4 |
Daily Patient Care Staffing: Emergency Department |
pdf 10k
doc 30k |
Instructions for Completing the HCQ-4 Form
pdf 10k
doc 23k
|
| HCQ-4A |
Daily Patient Care Staffing - Emergency Department (Spanish) |
pdf 13k
doc 32k |
Instructions for Completing the HCQ-4a Form
pdf 13k
doc 25k
|
| HCQ-5 |
Daily Patient Care Staffing: Post-Anesthesia Care Unit |
pdf 10k
doc 30k |
Instructions for Completing the HCQ-5 Form
pdf 10k
doc 22k
|
| HCQ-5A |
Daily Patient Care Staffing - Post Anesthesia Care Unit (PACU) (Spanish) |
pdf 13k
doc 32k |
Instructions for Completing the HCQ-5a Form
pdf 13k
doc 25k
|
| HCQ-6 |
Daily Patient Care Staffing-Other Licensed Health Care Professionals: Hospital-Wide |
pdf 10k
doc 28k |
Instructions for Completing the HCQ-6 Form
pdf 10k
doc 23k
|
| HCQ-6A |
Daily Patient Care Staffing - Other Licensed Health Care Professionals, Hospital Wide (Spanish) |
pdf 11k
doc 29k |
Instructions for Completing the HCQ-6a Form
pdf 11k
doc 25k
|
Patient Safety Reporting System
|
| Form # |
Title |
PDF/WORD |
Instruction/ Comments |
| HCQ-1 |
Report of Serious Preventable Adverse Event in a New Jersey Licensed Health Care Facility (for use on or after January 1, 2007) (formerly HCQO-19) |
pdf 22k
doc 90k |
|
| HCQ-2 |
Report of Serious Preventable Adverse Event in a New Jersey Licensed Health Care Facility - Root Cause Analysis (RCA) (for use on or after January 1, 2007) (formerly HCQO-20) |
pdf 16k
doc 61k |
|
DHSS Forms
