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Provider Unit NCPD Documentation Forms

The following 2022 Approved Provider documentation forms need to be used for the planning, implementation, and evaluation of all Provider Unit activities.  - Updated 5/2022

 

Documentation Forms

Clinical Activity Planning Documentation Form 

Clinical Content - Educational activities that contain content that is directly related to the provision of clinical care, i.e. Interpreting EKGs, Care of the Suicidal Patient, or Assessing Patients for Pulmonary Congestion. If you are planning content that is clinical in nature you must include Relevant Financial Relationship mitigation tools for individuals in position to control content to include proper disclosures required by the Standards for Integrity and Independence.

 

Non-Clinical Activity Planning Documentation Form 

Non-Clinical Content: Educational activities that contain content that is directly related to the professional development of the nurse, i.e. Leadership Training, How to be a Great Mentor, Resiliency in Nursing.


Educational Planning Table 2015 -- required

 

SCNA Approved Provider Standards for Integrity and Independence Toolkit Design MUST BE IMPLEMENTED BY MAY 31, 2022


     Disclosure Form 
    
Mitigation Worksheet

 

Standards for Integrity and Independence MUST BE IMPLEMENTED BY MAY 31, 2022

 

Commercial Support Agreement Form 2022


Annual Report Forms New Format

New On-line Annual Report Form -- REQUIRED ANNUALLY
SCNA Annual Report CE Summary Excel Template
  -- REQUIRED ANNUALLY

SCNA Annual Report Activity File Directions

SCNA Annual Report Form Tab Delimited Format Fields


Other Forms

2022 CEAC Manual 1-2023

2022 Provider Personnel Change Form

Online Version 2022 Provider Personnel Change Form

Approved Provider Educational Activity Evaluation Summary


 



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