Section 11-148.1-4 - Application and documentation for certified caregiver applicant(a) A certified caregiver applicant shall submit a written application on forms prescribed by the certifying agency.(b) An application is not complete until the certifying agency receives a written application which contains all information and supporting documentation required by this chapter.(c) Applicants may mail applications and supporting documentation to the certifying agency.(d) Incomplete applications will not be processed and will be considered closed by the certifying agency after ninety calendar days.(e) The application shall include:(1) A list of all persons who reside in the home;(2) An application and any supporting documentation for each substitute caregiver that will provide care in the home, as outlined in section 11-148.1-5, if applicable;(3) A physician's statement regarding the applicant's ability to provide care to adults with I/DD;(4) A current and accurate floor plan of the applicant's home that has been approved by the respective county building department;(5) A fire evacuation plan for the applicant's home that includes the location of exits, planned evacuation routes, fire extinguishers, smoke alarms, and wheelchair ramps, if applicable;(6) A signed consent form and all applicable processing fees for each person undergoing a background check so that the department or its designee can conduct a background check in accordance with section 11-148.1-44, which includes fingerprinting and employment history;(7) Three personal references;(8) Verification of a current tuberculosis clearance for the applicant and all household members, including children, in accordance with current department of health examination procedures and regulations, chapter 11-164.2, Hawaii Administrative Rules (HAR);(9) Verification of the applicant's current certification in first aid and cardiopulmonary resuscitation;(10) Verification of the applicant's license to practice as a registered nurse or licensed practical nurse; or certification to practice as a certified nurses aid, if applicable; and(11) Any other requirements in accordance with departmental policy.(f) An applicant may withdraw the application at any time during the application process by notifying the certifying agency in writing.Haw. Code R. § 11-148.1-4
[Eff 8/2/2021] (Auth: HRS §§ 321-9, 321-11.2) (Imp: HRS §§ 321-11.2, 321-15.2, 846-2.7)