TX HHS Form 8005. ICF/IID Nursing Supervision For Unlicensed Assistive Personnel (UAP) (Example Form)

The TX HHS Form 8005, ICF/IID Nursing Supervision For Unlicensed Assistive Personnel (UAP), is an example form designed to facilitate the supervision of unlicensed assistive personnel in providing nursing care to individuals with intellectual or developmental disabilities. This form helps solve the problem of ensuring that UAP are adequately trained and supervised to provide high-quality care, thereby promoting the health and well-being of these individuals.

The form is used in situations where RNs (registered nurses) need to document their supervision of LVNs (licensed vocational nurses) or other unlicensed assistive personnel who are providing nursing care under delegation. The form requires information such as the individual's name, date, and description of changes since the last visit, as well as delegated tasks and observed care instructions. Additionally, it allows for documentation of additional training provided and the individual's satisfaction with their care.

Key features of this form include the requirement for RN initials to indicate personal supervision, delegation, or revocation. The form also includes spaces for LVN initials and signatures. By using this form, healthcare professionals can ensure that they are meeting regulatory requirements and providing high-quality care to individuals with intellectual or developmental disabilities.

• The form is used in situations where RNs need to document their supervision of LVNs or other UAP who are providing nursing care under delegation.
• The form requires information such as the individual's name, date, and description of changes since the last visit.
• The form allows for documentation of additional training provided and the individual's satisfaction with their care.