Have had at least one year of direct Yes No N/A Verified Unable to verify N/A patient care experience as a registered Comments: nurse. RN Instructor(s) Name(s) License #/Expiration Date Date of Hire Other Credentials (P.T.; O.T.; L.C.S.W; N.H.A., etc.) A licensed practical nurse shall: Hold a current, unrestricted Virginia Yes No N/A Verified Unable to verify N/A license as a practical nurse; Comments: Hold a high school diploma or Yes No N/A Verified Unable to verify N/A equivalent; Comments: Have been graduated from a Yes No N/A Verified Unable to verify N/A practical nursing program; Comments: and Have had at least two years of direct Yes No N/A Verified Unable to verify N/A patient care experience as a licensed Comments: practical nurse. REGULATION NUMBERS/CRITERIA PROGRAM VISITOR 18 VAC 90-26-30. Requirements for instructional personnel (continued). Responsibilities. Other instructional personnel Yes No N/A Verified Unable to verify N/A shall provide instruction under the supervision Comments: of the primary instructor. LPN Instructor(s) Name(s) License #/ Expiration Date Date of Hire Credentials (P.T.; O.T.; L.C.S.W; N.H.A., etc.)
Have had at least one year of direct patient care experience as a registered nurse. Yes No N/A Verified Unable to verify N/A Comments: RN Instructor(s) Name(s) License #/Expiration Date Date of Hire Other Credentials (P.T.; O.T.; L.C.S.W; N.H.A., etc.) A licensed practical nurse shall: Hold a current, unrestricted Virginia license as a practical nurse; Yes No N/A Verified Unable to verify N/A Comments: Hold a high school diploma or equivalent; Yes No N/A Verified Unable to verify N/A Comments: Have been graduated from a practical nursing program; and Yes No N/A Verified Unable to verify N/A Comments: Have had at least two years of direct patient care experience as a licensed practical nurse. Yes No N/A Verified Unable to verify N/A Comments: REGULATION NUMBERS/CRITERIA PROGRAM VISITOR 18 VAC 90-26-30. Requirements for instructional personnel (continued). Responsibilities. Other instructional personnel shall provide instruction under the supervision of the primary instructor. Yes No N/A Verified Unable to verify N/A Comments: LPN Instructor(s) Name(s) License #/ Expiration Date Date of Hire Credentials (P.T.; O.T.; L.C.S.W; N.H.A., etc.)
OnSite_Visit_Report_Form_NurseAide.docx