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Academic_Performance_Evaluation_2015_12_09_RG1920

Object Type: Asset
In Folder: Blank Forms, 2006-2015

Other Documents

sdb:SO|c15b1e2b-eecf-45cc-bd86-a9afec83eaf6
46
Academic Performance Evaluation, December 09, 2015

IO_e07b14b9-c05e-4ca1-a25a-bd25cff55775

Academic Verification Form, December 09, 2015

IO_ceacdd94-c706-44c9-9397-13a1c64b3d3c

Certificate of Licensure Order Form, August 2011

IO_d6e9eb22-f889-4fe4-8bec-f665f98f5c80

Certification of Records, April 2010

IO_ce0e2cfa-8e9c-4895-9b74-242329d4d66b

Certified List of Kentucky Program of Nursing Graduates Worksheet, Undated

IO_891d55b1-eabf-46f2-8d1a-8093896d0dbc

Change of Practice Address for APRN with A (CAPA-CS), January 2012

IO_2e587277-1cd3-4c67-a3a1-ca7c1aae6c18

Checklist for Dialysis Technician Competency Validation, September 2007

IO_1e89686c-2e35-4d84-999e-e80c0a30a8b4

Complaints Against Nurses Process – Facility Complaint Form, Revised March 2010

IO_536e803e-bfb0-4556-b951-932201a5a03b

Complaints Against Nurses Process, Revised March 2010

IO_cf2a40da-3598-41ce-bfab-254259ce99e9

Counselor Evaluation, December 09, 2015

IO_9a58cdbd-5718-44e8-9584-898a3a7bd687

Counselor/Therapist Verification Form, December 09, 2015

IO_da646277-9059-4531-aba0-69aef6f62bb2

Curriculum Change Request, November 2007

IO_d9f4ede7-fa92-4030-a0e1-e99027f362bc

Dialysis Technician Change of Address Form, Undated

IO_abe7dfa8-1fc2-4926-8548-10b1a5e2e3b2

DT Credential Reissue Form, June 2014

IO_34711d9b-59c7-4a6a-ac57-90a1fb41e1ec

Employer Verification Form, December 09, 2015

IO_49fd660e-183d-4a31-bce2-d88ecdd699be

Establishment of an Secondary Site of a Pre-Existing Prelicensure Nursing Program, Undated

IO_1c1964e7-4793-4876-846f-55827b382a26

Individual Request for Review of Continuing Education Activity, April 2010

IO_afda6e9d-abcf-467f-a3de-a6140e5ac597

Individual Request for Review of Continuing Education Activity, Undated

IO_f4f7713c-d38e-4a09-bf19-006f532eae05

Kentucky Criminal Background Request Form, May 2015

IO_3f633c4c-0af0-4a4d-95f3-5a3dbbb657da

Kentucky Nurse Aide Registry (KNAR) Data Roster Download Request Form, August 2011

IO_ed5259cd-cacb-44f9-bd62-4238b52d781b

List of Dialysis Technician Training Program Graduates, September 2007

IO_bae5ea52-1c5f-49cc-ab8e-0d777d2cab6f

Medication Report, September 14, 2006

IO_d6a509c9-8d20-433f-a2bf-ee71b7b7fc40

Monthly Meeting Documentation, March 02, 2009

IO_1d4b6907-894c-4823-b819-1b59089a01d8

Monthly Self Report, April 19, 2010

IO_36ac3a27-b0f9-414f-b208-d86fe33904e8

Name/ Address Change Request Form, April 2010

IO_900d1aed-c902-4db6-a12a-dc6f1ebbe394

Notification of a Collaborative Agreement for the Advanced Practice Registered Nurse Prescriptive Authority for Controlled Substances (CAPA-CS), December 2014

IO_6413eb29-a78f-454d-b260-4bfaf6a01ded

Notification of a Collaborative Agreement for the Advanced Practice Registered Nurse’s Prescriptive authority for Nonscheduled Legend Drugs (CAPA-NS), December 2014

IO_e51c7ec5-fb9e-4df6-9718-be1066ca320d

Notification to Discontinue the CAPA-NS After Four Years, December 2014

IO_758297c2-90ed-4080-9c5d-e680757eb981

Nursing Faculty Update, February 2013

IO_b6cb2fba-bb63-4217-b3c9-aa838594f6d9

Preceptorship Verification Form, Undated

IO_17207ba3-006f-40d6-9cdb-b9b891958478

Prelicensure Nursing Program (PON): Clinical Instructor Record, Undated

IO_cdf28985-540c-47ab-aa79-ea84468b0a5f

Prelicensure Nursing Program (PON): Non-Nurse Faculty Record, Undated

IO_1e8d7b0c-d113-4909-bcfa-2670e00e7df5

Prelicensure Nursing Program (PON): Program Administrator Record, August 2009

IO_7482acd3-0a4d-48df-b6f9-22c8eddd2c44

Prescription Medication Report, Revised December 09, 2015

IO_d248deab-343e-48b1-ac65-a2580ad3860d

Probation/Parole/Drug Court Report, Revised December 09, 2015

IO_034ddf4b-c736-4b95-b9f9-152ada2709a4

Probation/Parole/Drug Court Verification Form, Revised December 09, 2015

IO_fff441b2-fb53-4229-bc19-338b447d4481

Relapse Prevention Plan, Revised December 09, 2015

IO_1ff362b7-ad46-47c5-aaea-a98f2257d6a4

Request for a New APRN Program, Undated

IO_0d63d951-fe43-4c96-8b83-bc3c7364f524

Rescission of a Collaborative Agreement for the Prescriptive Authority for Controlled Substances (CAPA-CS), December 2015

IO_a1dbdd4b-b3b5-4bc1-9e60-42a87d3b793c

Sexual Assault Nurse Examiner (SANE) Data Roster Download Request Form, December 2011

IO_ae2e3611-d9e3-482f-b8b7-96cce693b595

SRNA Private Duty Form, Undated

IO_8f3e1f4e-f90c-4b28-86e0-edec2af5bf73

Treating Practitioner Verification Form, Revised December 09, 2015

IO_7174eb74-5989-4733-b073-6c5b8cc4f839

Verification of Licensure to an Entity or Person Other than a Board of Nursing Request Form, June 2014

IO_a45800ca-e033-4725-8fe2-9a01c5aea9ee

Voluntary Relinquishment for a License or Credential, February 2011

IO_1ff5946f-0e8d-45fa-a2dd-52c3751cc489

Waiver of Confidentiality, July 15, 2010

IO_26eca64a-a2a9-49e6-a3ab-d919cc8f9cfa

Work Performance Evaluation, Revised December 09, 2015

IO_2c9b52b5-c0ea-4251-894c-b80f06eccf9a

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