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

TX HHS Form 8005, "ICF/IID Nursing Supervision For Unlicensed Assistive Personnel (UAP) (Example Form)", is a practical tool for ensuring the continued competency of unlicensed assistive personnel (UAP) in providing nursing care to individuals with intellectual and developmental disabilities. This form helps solve the problem of maintaining accurate records of supervision and training provided to UAP, thereby promoting high-quality care and patient safety.

The form requires key information such as the individual's name, date, and a description of changes since the last visit. It also includes sections for documenting delegated tasks, observed care instructions, and additional training or reinforcement provided. The form should be used whenever UAP are involved in providing nursing care to individuals with intellectual and developmental disabilities, ensuring that their skills and knowledge are up-to-date and effective.

This example form is designed for use by registered nurses (RNs) who personally supervise licensed vocational nurses (LVNs). It includes spaces for the RN's initials, print name, and signature, as well as those of the LVN. The form does not require completion if the RN has revoked delegation or observed that the LVN's continued competency is in question.