6o.m.=GZh&v#x[S}p_^wfobMimSMo5\Xu#. The Provider Search below allows users to search for providers by name or services. A medication administration record to document any medications given as instructed in rule 65G-7.008, F.A.C. xb```b``a`a`` |@1V EK(X4M#SqmUR)IkIdu="cn8x6w$r)p&.>'`[9 a NhPB,Ge7gY(Wm?H]*sP M+?7~ V2 tHp\jf`LZeP*F!4. The Off-Site Medication Form, APD Form 65G-7.009 A, as adopted in rule 65G-7.009, F.A.C. P D word/document.xml][oH~_i485(zVgV)T~.v ;i* :uN\~4 K]g~=]zg%nH#r[?|So6%QjAQ2Eo0&d&c4C:9SmbF=$=IOV7-FcA[cnPt8uYj4a.n{CaP%X-J%o 4J&A|+NT74Tc^Uhp9bYaEi(je$EUoSdQVM8b8NlW[V2fy%*(IzOOe(cgdLGtk>|v )A~?-bhfO\aKc%v=(n>;K($iMS:mZOMQcE?~vto#4?gJ+Nq".+-oMqRHD?^R%/&,qA3/zU=[]s;!^NSu`E`$#X0ay]qL/X:m8)v9P3p[qUw>6(gO/ DHt. endstream endobj startxref %%EOF hbbd```b``:"IMZ `= EfI.20,~," IQ T&`$ 0 #4 0000007895 00000 n All over-the-counter medications being administered to the client must have a written physician's order documented in the client's record per Section 17a-210-6. or call the PPL Customer Service Team at 1-844-842-5891. From Wikimedia Commons, the free media repository. 0000007295 00000 n hbbd``b`s " follow up DDD Medication Administration Assessment can be administered. trailer Governor Sheila Oliver, Improving Health Through Leadership and Innovation, Guide to Completing Asbestos Management Plan Forms, Instructions for Completing Sample Submittal Forms, Instructions for Completing the Application for a Clinical Lab License, Guidelines for Requesting Certificates of Free Sale (Updated November, 2016), Immunization Reporting & Auditing Guidelines, Instructions for Completing the imm-20 Form, Guidelines for Uniform Shared Public Health Services Agreement, Additional Information for Completing the OCC-31 Form, NEW! Employee obtained key and opened box. Medication 20A Prescription Medication 20B PRN (as needed) Prescription Medication 20C PRN Over the Counter (OTC) Medication 20D Medication Storage 20E Medication Administration 21. 0000003968 00000 n H-o1a7RI*0a!xkvt]5l! Search arrest records and find latests mugshots and bookings for Misdemeanors and Felonies. Title: iRecord 3.0 User Guide. Hb``Pc``, p@i The user is on notice that neither the State of NJ site nor its operators review any of the services, information and/or content from anything that may be linked to the State of NJ site for any reason. 10:161A, Symptom Assessment for Pulmonary Tuberculosis (TB), Religious Exemption - School TB Testing/Symptom Assessment Form, Statement of Non-Infectiousness for Symptomatic Individual, Statement of Non-Infectiousness for Individual with TB Disease, Record of Contact Interview (Original + 1 Continuation Page), Record of Contact Interview (Original + 2 Continuation Pages), Record of Contact Interview (Original + 5 Continuation Pages), New Jersey Tuberculosis Case, Suspect and Status Report, Vaccine Adverse Event Reporting System: Online, Inspection Report of Kennels, Pet Shops, Shelters, and Pounds, List of Licensed Kennels, Pet Shops, Shelters and Pounds, Certification of Veterinary Supervision of the Disease Control and Health Care Program at a Licensed Animal Facility, Notice of Intent, State-Sponsored Municipal Rabies Vaccination Clinics, State-Sponsored Municipal Rabies Vaccination Clinic Report, Certificate of Exemption from Rabies Vaccination, Application for Animal Control Officer Certification, Medical Documentation for WIC Formula and Approved WIC Foods for Infants, Children and Women, Designation of Infant Formula Manufacturer, Retailer, Wholesaler and Distributor, Vendor Agreement (without signature page), Authorization AGreement for DirectDeposit (ACH) Credits, NJ WIC Health Care Referral (Infants and Children). The user is on notice that neither the State of NJ site nor its operators review any of the services, information and/or content from anything that may be linked to the State of NJ site for any reason. cup, water, etc). Google Translate is an online service for which the user pays nothing to obtain a purported language translation. The PDD can be determined from studies of prescriptions, medical or pharmacy records, and it is important to relate the PDD to the diagnosis on which the drug is used. DHS Offers Webinar on Newly Released Regulations 0000002762 00000 n With MAR, users can schedule and add comments to medications and treatment records, and export MAR reports with current medications and treatments on a monthly grid. Hemolytic Uremic Syndrome (Postdiarrheal) Report, Epidemiology Surveillance Record (Hospital-Based Laboratory), Report of Known or Suspected Avian Chlamydiosis (Psittacosis), Outbreak Report for Long Term Care and Other Institutions, Outbreak Report for Child Care, School and Camp Settings, Child Care Center - DOH Subsequent Notification, Statement of Education and Experience Requirements, Checklist for Public Recreational Bathing Facilities, Notification of Non-Friable Asbestos Work Activities, Notification of Non-Friable Asbestos Work Activities Related to Superstorm Sandy, Contractor Information for Non-Friable Asbestos Work Activities, Body Art or Ear-Piercing Establishment Report of Infection or Injury, Physician Report Form (Non-Hospital Source), Application for Cottage Food Operator Permit, Child Health Conference - Health Assessment (Infancy: 2-6 Weeks), Child Health Conference - Health Assessment (Infancy: 2 Months), Child Health Conference - Health Assessment (Infancy: 4 Months), Child Health Conference - Health Assessment (Infancy: 6 Months), Child Health Conference - Health Assessment (Infancy: 9 Months), Child Health Conference - Health Assessment (Infancy: 12 Months), Child Health Conference - Health Assessment (Childhood: 15 Months), Child Health Conference - Health Assessment (Childhood: 18 Months), Child Health Conference - Health Assessment (Childhood: 2 Years), Child Health Conference - Health Assessment (Childhood: 3 Years), Child Health Conference - Health Assessment (Childhood: 4 Years), Child Health Conference - Health Assessment (Childhood: 5 Years), Child Health Conference - Health Assessment (Childhood: 6 Years), Child Health Conference - Health Assessment (Childhood: 7 Years), Child Health Conference - Health Assessment (Childhood: 8 Years), Child Health Conference - Health Assessment (Childhood: 9 Years), Child Health Conference - Health Assessment (Childhood: 10-12 Yrs), Child Health Conference - Health Assessment (Childhood: 13-15 Yrs), Child Health Conference - Health Assessment (Childhood: 16-20 Yrs), Child Health Services Quarterly Summary Report, Care Plan for Children with Special Health Needs, Organic and Inorganic Chemistry Sample Submittal, Application for a Clinical Laboratory License, Blood Bank Annual Statistics (Out of Hospital and Emergency Only Transfusion Facilities), Disclosure of Ownership and Control Interest, Blood Bank Annual Statistics (Umbilical Cord Blood Facilities), Laboratory Personnel Qualification Appraisal, Blood Bank Personnel Qualification Appraisal, Brokers and Reagent Manufactureres - Annual Statistical Data, Request for Funding from Civil Monetary Penalties, Clinical Laboratory Improvement Amendments (CLIA) Application for Certification, Full Review Certificate of Need Application for Long Term Care Facilities: General Long Term Care Beds; 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Staff persons may participate in a . endobj DDD develops policies that conform to state, federal, and contractual requirements. DDD Day Program Manual 11/06 Forms: Form F(9) MEDICATION RECORD (must be completed in ink) NAME INITIALS Individual's Name: 1. You can use Facility Locator to locate your nearest .A veteran is entitled to an annual clothing allowance for each prosthetic or orthopedic appliance (including, but not limited to, a wheelchair) or medication used by the veteran if Clothing Allowance is a single, annual allowance paid out to the veteran, in the sum of $753. endstream endobj startxref endobj Mailing Address: Administrative Office PO Box 726 Trenton, NJ 08625-0726 Office: Department of Human Services building 222 South Warren Street Trenton, NJ 08625-0700 2023 February 2023 February 7, 2023 !!NEW!! Call NJPIES Call Center for medical information related to COVID. DDD Medicaid Providers - If your information is inaccurate, click the following link to download the. medication(s) for MAID. Date of Report . Download the form We Are Proud of Letting You Edit Medication Administration Record In the Most Efficient Way Take a Look At Our Best PDF Editor for Medication Administration Record Download the form People Also Search For Application for Approval to Operate a Body Art Establishment (Permanent) For use by Local Health Department Officials only. Initial Uniform Application for Services to Individuals 21 and Under with Developmental Disabilities: pdf (33k) doc (61k) FHS-18: . In the future, additional features will be available, including the ability to search by radius around a zip code, catchment area and by keywords. Word version contains instructions. 0000002533 00000 n 8.2 Medication records shall carry the following essential information: 8.2.1 Member's name 8.2.2 Name and strength of drug 8.2.3 Route of administration Duty Area 6: Medication Administration Records (MARs) and other forms 71-78 Duty Area 7: Demonstrate the Five Rights of Medication Administration 79-86 . Message of the Day Welcome to the new Provider Search! ; 4. 0000001468 00000 n 0000001670 00000 n COVID-19 is still active. o word/_rels/document.xml.rels ( MO0H*wu] iWk:mDTZ-RkOU|ud$).s>'CV 9Y#j%W%v9GJ@1?*>%mb%`0_Lj&"'vVxk!$' 3. ?`:`tOH/_MCJXX;LMV2~=c$ 3(p\w}3vA\$e 05eBQZL 8l/;dz;(Twkmc.>~i7/i !$F?K$+`/G>S%l0UjjPkkkd.59=d]nm0 93y$A\@sZ*RnebmMKcju VZK2ck:F80 WzRejh Application to Amend a New Jersey Vital Record / Application for a Certified Copy of Amended Record (Updated February 7, 2019) pdf . Over-the-counter medications may be purchased in bulk supply as long as client-specific physician orders are in place in the client record. Service Plan 24. To receive Division Circulars, special alerts related to Division Circulars, and regulation updates by email, send a request to DDD-CO.LAPO@dhs.nj.gov and include your name, email address, and affiliaton (agency, individual, family, advocate, etc. Please select a role from drop-down to login. Version: 1.113 0000002688 00000 n o~^t|??hM2Wto>?y Y2t"rc. To learn more about using our criminal records searches and other background check services, please contact Corra Group at 310-524-9800 or email us: [email protected] D. Explore the safest neighborhoods in the U. "Hw"w P^O;aY`GkxmPY[g Gino/"f3\TI SWY ig@X6_]7~ SOURCE: Emergency rule adopted at 23 Ill. Reg. We are pleased to announce that the New Jersey Department of Health has launched a program that can provide in-home COVID-19 vaccine appointments for homebound persons and has begun accepting requests for this important service. Google Translate is an online service for which the user pays nothing to obtain a purported language translation. 0000001144 00000 n Lt. [.-gR\O54 >G7Nl6ebus *b]]G5;BT4R. 0000003054 00000 n for electronic AND hand-written completion. % You have multiple roles. Medication Administration Medication Administration Medication administration training and certification developed by DODD authorizes caregivers to perform a variety of tasks for people with many different medical conditions. ), Catastrophic Illness in Children Relief Fund (CICRF), Commission for the Blind & Visually Impaired (CBVI), Division of the Deaf & Hard of Hearing (DDHH), Division of Developmental Disabilities (DDD), Division of Medical Assistance & Health Services (DMAHS), Division of Mental Health and Addiction Services (DMHAS), Office for Prevention of Developmental Disabilities, Office of Program Integrity & Accountability, Public Advisory Boards, Commissions & Councils, Memo from Deputy Commissioner Apgar regarding rescinding DC #33, Assistant Commissioner Ritchey Letter regarding Division Circular #34, Behavior Support Plans, DEVELOPMENT AND PROMULGATION OF DIVISION CIRCULARS AND QUALITY ENHANCEMENT PROCEDURES, CONTRIBUTION FOR CARE AND MAINTENANCE REQUIREMENTS, MANAGEMENT OF FUNDS WHERE DDD OR THE PROVIDER IS REPRESENTATIVE PAYEE FOR AN INDIVIDUAL'S BENEFITS, PRINCIPLES AND GOAL OF THE DIVISION OF DEVELOPMENT DISABILITIES, GUARDIANSHIP: NEED, APPOINTMENT, CONTINUITY, COMMUNITY CARE WAIVER WAITING LIST PROCEDURES, COMPLAINTS FILED UNDER THE AMERICANS WITH DISABILITIES ACT (ADA), COMPLAINT INVESTIGATIONS IN COMMUNITY PROGRAMS, DEFENSIVE TECHNIQUES AND PERSONAL CONTROL TECHNIQUES, MECHANICAL RESTRAINT AND SAFEGUARDING EQUIPMENT, REFERRALS FOR PLACEMENT FROM DEVELOPMENTAL CENTERS AND TRANSFERS TO COMMUNITY LIVING ARRANGEMENTS, REPRESENTATION, INDEMNIFICATION, AND EXPUNGEMENT OF ARREST RECORDS OF DIVISION EMPLOYEES AND FORWARDING OF LEGAL PAPERS, RECORDS CONFIDENTIALITY AND ACCESS TO CLIENT, DIVISIONAND PROVIDER RECORDS, AUTHORIZATION FOR EMERGENCY MEDICAL, SURGICAL, PSYCHIATRIC OR DENTAL TREATMENT, TRANSFER OR DISCHARGE FROM CONTRACTED PROVIDER, DEATH AND FUNERAL ARRANGEMENTS OF A PERSON RECEIVING SERVICE, PAYMENTS TO OPERATORS OF COMMUNITY CARE RESIDENCES (, SKILL LEVEL DETERMINATION AND COMPENSATION, PLACEMENTS FROM COMMUNITY SERVICES INTO PSYCHIATRIC HOSPITALS, COMMUNITY SERVICES SYSTEM OF CASE MANAGEMENT, HIPAA-ADMINISTRATIVE POLICIES AND PROCEDURES, HIPAA-USES AND DISCLOSURES POLICIES AND PROCEDURES, HIPAA-CLIENT RIGHTS POLICIES AND PROCEDURES, Federal Deficit Reduction Act of 2005, Section 6032 - Policy on Fraud, Waste and Abuse, Federal Deficit Reduction Act of 2005, Section 6032 - Policy on Compliance. hb`````f`a`2f`@ +sL Xdjz%$M xS8/;klw Ig10@b`<3n9/}k(@ g Microsoft Word - F9 Medication Administration Record.doc Application for Approval to Operate a Body Art Establishment (Temporary) For use by Local Health Department Officials only. 0000001853 00000 n Y$M6R};gK~#w0G]VrsN}y6:n$RgWl{OW?f\)*UT)TzhXuK. 11988, effective September 13, 1999, for a Any changes or additional submission processes will be posted to the Department of Health website. j)LdrJr+ew>ni\9)>9e3w]xW`C g0^:LhxG/KG~ pWO:+89MUozeu|:xbf}\Wy3CiSjr4~sNgW endstream endobj 21 0 obj << /Type /FontDescriptor /Ascent 905 /CapHeight 718 /Descent -211 /Flags 32 /FontBBox [ -665 -325 2028 1006 ] /FontName /OIIMPL+Arial /ItalicAngle 0 /StemV 94 /FontFile2 41 0 R >> endobj 22 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 146 /Widths [ 278 0 0 0 0 0 0 0 0 0 0 0 278 333 278 0 556 556 556 556 556 556 556 556 556 556 278 0 0 0 0 556 0 667 0 722 722 667 0 778 722 278 0 0 556 833 722 778 667 0 722 667 611 0 667 0 667 667 0 0 0 0 0 0 0 556 556 500 556 556 278 556 556 222 0 0 222 833 556 556 556 556 333 500 278 556 500 722 0 500 500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 222 ] /Encoding /WinAnsiEncoding /BaseFont /OIIMPL+Arial /FontDescriptor 21 0 R >> endobj 23 0 obj 745 endobj 24 0 obj << /Filter /FlateDecode /Length 23 0 R >> stream Completion of the Medication Module on CDS prior to July 1, 2014 will not be accepted for pre-service requirements. H1Fa>WaZdqXUJz Xi[`Dy2lGmdnbv5? jF-ny8oO?[Z5z~au^?~uc SxmYwn#>9Vki?X82m %PDF-1.3 % -Read Full Dislaimer, Determine whether you are eligible to receive services from the Division's provider network, Public and quarterly update meetings schedule, Apply for a rental subsidy from the Supportive Housing Connection, Learn about job training services and employment options. 104 0 obj <>stream Doctors order form (Hold Harmless- signed by physician, parent) (Permission To Retain Form-signed by the physician, parent, and student) The medication in the original pharmacy container. Duty Area 7: Demonstrate the Five Rights of Medication Administration 69-76 . 13094 0 obj <> endobj 0000075899 00000 n Title: Medication Administration Record (MAR) Last modified by: ltolchin Created Date: 9/5/2008 4:12:00 PM Company: SDRC Other titles: Medication Administration Record (MAR) Service Plan Specific Training (medication trainings), the current payment is $341.54. Catastrophic Illness in Children Relief Fund (CICRF), Commission for the Blind & Visually Impaired (CBVI), Division of the Deaf & Hard of Hearing (DDHH), Division of Developmental Disabilities (DDD), Division of Medical Assistance & Health Services (DMAHS), Division of Mental Health and Addiction Services (DMHAS), Office for Prevention of Developmental Disabilities, Office of Program Integrity & Accountability, Public Advisory Boards, Commissions & Councils, Office of Education of Self-Directed Services. %PDF-1.5 % org provides free access to printable PDF Form MI-1040 is the most common individual income tax return filed for Michigan State residents. "Community Services" means a component of the Division of Developmental Disabilities which provides housing and supportive services to aid persons with developmental disabilities in establishing themselves in the . 0000002280 00000 n trailer << /Size 46 /Info 4 0 R /Root 7 0 R /Prev 77665 /ID[<0c226b5500007d2f0ee1517cbce23df1>] >> startxref 0 %%EOF 7 0 obj << /Type /Catalog /Pages 3 0 R /Metadata 5 0 R /PageLabels 2 0 R >> endobj 44 0 obj << /S 36 /L 133 /Filter /FlateDecode /Length 45 0 R >> stream Concerns have previously been raised about the common use of paper-based medication administration records. 0000000016 00000 n *W'D3`Jvqz6$uhkqBk'AA$- 2\q>st-DRysdK+d4^+KP]Ve3IQiks8^K/+nc%mrm"}VX{^8Z xp9K`y_t PK ! Provider Search Filter Long Term Care Systems, New Jersey Department of Health and Senior Services, who contributed their time, knowledge, and talents to the development and revisions of this . If OTC, in the original box with student's name The information on the container must match the written order. HIo1F+|FL.'$bX}C(U"Sv'$.T]~,w'&b,d.U|}=ZvTL6/.3/ne12%f9-XIrN-#kSntnzqzeWf~ [JBy'?//73[*>kv@sHx$L/~7g_UJt\sW7o,[k'gXFM0q9{8/629s~cH&)7cy1W#n c.Q4Qz{Xwkr 6)l},H!O.aMdsr4bPeDJA]s{wsZ3aMJy!5YH8Kmv!k@,/3!ZR&J8sL\0}jv %PDF-1.4 % dg>$)7k/W5Ro)G|>BfB0&9c3ADeh;sCYLQ]vY*TQLa.$'hE.i, /%C _`wML}w`6Bxp^ PK ! . Date: 2/15/2023. Section 116.70 Medication Administration Record and Required Documentation Section 116.80 Storage and Disposal of Medications . Daily Training Records 25. endobj 0000008500 00000 n NEW! Individual Records 28. The CDS training module has been updated with NJ specific content and annotations to ensure staff are familiar with NJ policies and regulations as noted in the classroom training. The prescribed daily dose (PDD) is defined as the average dose prescribed according to a representative sample of prescriptions. (fFv~V%446_s95O\+}CQd1e(2)BBDb6U)t!o.8 Gc>\L`hQlL`:pv*WmeG&FI$'z?bgX/("JR&ImgbjUi0uD(:^h2*8w!Q$$ kyDX>(un^,^.}4d.=\|qj2,$2BDCqmx82u%3]%R8K1bkV32;yD4+x]o?^ls!6xMA\8673`_t)\{ZFxzQiW !qDEfw/9vz@xZ=exH^Z!CNDZ1>(JstT8_F96ef HVnF}W(wI)dC&qdvZT J-g{H .3M\% 6 0 obj << /Linearized 1 /O 8 /H [ 1233 232 ] /L 77911 /E 76007 /N 1 /T 77674 >> endobj xref 6 40 0000000016 00000 n Augusta, NJ 07822 Subject: Medication Departments Affected: All Programs Effective Date: 3/1/19 Replaces Policy: 10/9/87; 2/23/90; 4/15/92 . 1 0 obj <> S=eV*d={[`gY@:@BEx)m7h8.G/ Lzm?`$w5j*{_*^qU3d Mock Medication Administration Observation Checklist (Initial Only-Not Required for Recertification) Areas of Demonstration Mock Trial CommentsDate: Yes No 1. Medication Administration Record (MAR) Form D.401. 0000005319 00000 n 0000002475 00000 n 3 0 obj HCANJ | New Jersey (NJ) NursingCenter and Assisted Living Providers GBuLFk[@fx,m&l'lq~,%Ygmfv 1&-mff(,.2J)b?y_!mnuSbG1q1Q}RG1Q>>(>Jb(>/(>R(>Jbb(>R(>1=8M T1_\S"c"H)%RLC"iJL bH)J_ Lh endstream endobj 29 0 obj 506 endobj 30 0 obj << /Filter /FlateDecode /Length 29 0 R >> stream 0000000693 00000 n xref c MH 6D 0000004350 00000 n The forms are listed alphabetically by form number in PDF and Word template format. %PDF-1.5 % Kl],q,[-?A%v fw{XJMqxh iugdnNuSscWJ 0000002067 00000 n The health care practitioner may utilize the Medication Administration Record Form, APD Form 65G-7.008 A, as adopted in rule 65G-7.008, F.A.C. DDD Provider Agreement - (DDD-PA 01-03-2019) 8. !V]Bu b%KHU. 0000007316 00000 n !U]BU6Au b%] b%dKU.!U]BR%KU. 8.0 Medication Records 8.1 The Medication Administration Records (MAR) shall be checked against the physician's orders monthly by two qualified Hab Techs or nurses. Affirmative Action Survey (optional) 12. \Jhzv).q&9Ln+wl!l1Z_1jK3\&OdCpgx1=GoeZr})@T{$W;0HOD#"MS\thh=K8g-R\B$g&C;%+_+L-|@7wahBX.jm=?3~_W1#l B&Nq_q##,_k@1-]5u vo{x!9 KNK www.publicpartnerships.com. The State of NJ site may contain optional links, information, services and/or content from other websites operated by third parties that are provided as a convenience, such as Google Translate. 0000004971 00000 n A copy of the Agency's form "Medication Administration Record," APD Form 65G7-00 (3/30/08), incorporated herein by reference, may be obtained by writing or calling the Agency for Persons with Disabilities, at 4030 Esplanade Way, Suite 380, Tallahassee, FL 32399-0950; main phone number (850)488-4257. Disclosure of Ownership and Control Interest Statement (06/19/2012) 9. 0000006691 00000 n hUhUk+?ijmfBcrk8n:i9*h+"(l#QhC:0pJ%1w~y 9 F(_[@B The forms are now ONLY available for download on the EDRS System. The New Jersey Registered Pharmacist shall also be required to complete the one-day orientation course. 0000010457 00000 n For more information and to review Training Reimbursement Payment FAQ, please visit PPL's NJ DDD Program webpage at . DDD Day Program Manual 11/06 Forms: Form F5 STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES - DIVISION OF DEVELOPMENTAL DISABILITIES Medical Form for Adults Name: _____ Age: _____ DOB: _____ { } Male { } Female . Compensation 26. 6. Adult Medical Day Care Inspection Information, Pediatric Medical Day Care Inspection Information, Affidavit of Compliance Assisted Living Residences, Comprehensive Personal Care Homes and Assisted Living Programs, Affidavit of Compliance with N. J. Licensure Standards for Adult Day Health Care Facilities, Declaration of Compliance with Advisory Standards, Consumer Resident/Patient Complaint Report, Affidavit of Compliance with N. J. Licensure Standards for Pediatric Medical Day Care Facilities. 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