DSHS Form 07-097 "Individual Provider Planned Action Notice Training/Certification (Home and Community Services)" - Washington (Lao)

Form DSHS07-097 LA is a Washington State Department of Social and Health Services form also known as the "Individual Provider Planned Action Notice Training / Certification (home And Community Services)". The latest edition of the form was released in March 1, 2018 and is available for digital filing.

Download an up-to-date Form DSHS07-097 LA in PDF-format down below or look it up on the Washington State Department of Social and Health Services Forms website.

Download DSHS Form 07-097 "Individual Provider Planned Action Notice Training/Certification (Home and Community Services)" - Washington (Lao)

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vz n tI K wgVbEc™ g kan

AGING AND LONG-TERM SERVICES ADMINISTRATION (ALTSA)

DEVELOPMENTAL DISABILITIES ADMINISTRATION (DDA)

VbEc™ g kankAtµtI Æ T J k vagwwkmaSµlz b ÏU ™ e bi Æ g EYgdU E lSÆ v nbu k ˚q n

kanƒj k ƒq n /kanyx g yJ n

Individual Provider Planned Action Notice Training / Certification

s J Æ ElA tI Æ y U Æ K wgÏU ™ e bi Æ g EYgdU E l

kankAtµtI Æ T J k vagwwkma

k q d HmaYp q k ˚wgr z d v M s i g † z n

b z n c u k q d kµn q d Sµl z b kanƒ j k ƒ q n ElA/Hl J kany x g

Washington Administrative Code (WAC) Chapter 388-71

y J n t I Æ c µep z n ef J Æ w cAm I e g J Æ w nRKt I Æ c Aeh z d vWk ElA T J k c Æ a Yeg i n VH ™ o dY

Hl J

Aging and Long Term Care Support Administration (ALTSA)

VnTanAep z n Ï U ™ e b i Æ g EYgd U E lS Æ v nb u k ˚ q n /fAn z k ganeb i Æ g EYgb q v rAb z d rAYAYav.

Developmental Disabilities Administration (DDA)

w z n n [ E m Æ n ef J Æ w cAEc ™ g VH ™ t Æ a nsabv Æ a el [ m † X n † x g E† Æ

k q m

Hl J

Department of Social and Health Services (DSHS)

Area Agency

kµl z g cA:

on Aging (AAA)

pA† i e Sd / † z d kanc Æ a Yeg i n VH ™ t Æ a nVnTanAep z n Ï™ U e b i Æ g EYgd U E lS Æ v nb u k ˚ q n ;

pA† i b z d K x n †wnef J Æ w cA† z d S z n Yakanb M r i k anl U k ˚ ™ a KwgÏ U ™ e b i Æ g EYgd U E lS Æ v nb u k ˚ q n Kwgt Æ a n.

t Æ a nb B R d ™ T J k wAn u Y adVH ™ e h z d vWkep z n Ï U ™ e b i Æ g EYgd U E lS Æ v nb u k ˚ q n ElA k q m

cAb B c Æ a Yeg i n VH ™ t Æ a nSµl z b t u k @s q Æ v omgt I Æ R d ™ e h z d vWkVnv z n t I Hl J Hl z g cak

DSHS

v z n t I y U Æ K ™ a get i g n [ T ™ a Hakv Æ a t Æ a nb B R d ™ S µer z d k q d kµn q d Kwgkanƒ j k ƒ q n /kany x g y J n Kwgt Æ a nk Æ w nv z n t I t I Æ T J k bq Æ g Rv ™ . t Æ a ncAb B e h z d vWkef J Æ w cAeg i n cakk q m

DSHS

ElA

w I k c q n kv Æ a t Æ a nRd ™ S µer z d k q d kµn q d Kwgkanƒ j k ƒ q n /kany x g y J n t I Æ † ™ w gRd ™ e h z d

t Æ a nRd ™ T J k wAn u Y adVH ™ e h z d d z Æ g n x n odYk q m

Hl J

DSHS

AAA.

l U k ˚ ™ a Kwgk q m

Ï U ™ t I Æ t Æ a neh z d vWkVH ™ c AT J k Ec ™ g bwkT ™ a Hakv Æ a t Æ a nb B S µer z d kanƒ j k ƒ q n /kany x g y J n t I Æ † ™ w gRd ™ e h z d k Æ w nv z n t I † aYo†, k q m

cAb B

DSHS

c Æ a Yeg i n VH ™ S µl z b kanb M r i k anKwgt Æ a nVnv z n t I Hl J Hl z g cak v z n t I t I Æ m I Ï q n Vs ™ k anRd ™ ElA eK q a ec X a cA† ™ w gRd ™ s wkHaÏ U ™ e b i Æ g EYgd U E l˚ q n VHm Æ .

t Æ a ncAb B S amadt I Æ c Aeh z d vWkRd ™ Y ™ w nv Æ a t Æ a n:

b B R d ™ T J k y x g y J n odYk q m

v Æ a ep z n Ï U ™ s Æ v Yy U Æ † ameh J w nfaYVnKwbeKdevlat I Æ T J k b q Æ g Rv ™ ;

Department of Health (DOH)

b B R d ™ S µer z d kanƒ j k ƒ q n t I Æ † ™ w gkanfaYVnKwbeKdevlat I Æ T J k b q Æ g Rv ™ o dYw I g †amraYrAwWdcak

kanƒj k ƒq n tI Æ † ™ w g kan

Training Partnership.

t I Æ t Æ a nb B R d ™ S µer z d Em Æ n :

kanƒ j k ƒ q n f { n Tan;

kanS j k Sadµen I n † B R p.

bB m I Ï U ™ s Æ v YyU Æ † amehJ w n Hl J kanh z b hwgt I Æ m I ˚ u n nAv u d t i t I Æ T J k wwkVH ™ o dY

y Æ a gw J Æ n @† B R pw I k El ™ v tI Æ y U Æ V nSAfabVs™ k anRd™ ElA y U Æ V nSAfabd I

DOH

t z g Swgy Æ a g.

_______________________________________________________________________________________________

kankAtµwz n n[ R d™ T J k ehz d lq g RpodYwI g †amSi d wµnad†B l q g Rpn[

k q d rAbWbt I Æ k Æ W vf z n nµk q d kµn q d Sµl z b kanƒ j k ƒ q n ElA kany x g y J n Sµl z b Ï U ™ e b i Æ g EYgd U E lS Æ v nb u k ˚ q n /fAn z k ganeb i Æ g EYgb q v rAb z d rAYAYavcAT J k f q b eH z n y U Æ V n

k q d HmaY

Rphwd

kank Æ a veT i g w z n ecaAc q g † B l q g Rpn [ c As Æ v Yt Æ a nRd ™ H laY:

WAC 388-71-0500

WAC 388-71-1130.

kq d rAbWbtq Æ v Rp(bz n rAYaYvÆ a EmÆ n VÏEdÆ c ATJ k bq Æ g VH™ T J k ƒj k ƒq n Hl J yx g yJ n , kanYq k evx n , k q d kµn q d k Æ W vk z b ewkSany x g y J n , wJ Æ n @):

WAC 388-

71-0500; WAC 388-71-0520; WAC 388-71-0540; WAC 388-71-0551; WAC 388-71-0561;

ElA

WAC 388-71-0836; WAC 388-71-0975

WAC 388-71-0523

kq d kµnq d kÆ W vkz b kanƒj k ƒq n f{ n Tan:

WAC 388-71-0870; WAC 388-71-0875; WAC 388-71-0880; WAC 388-71-0885;

ElA

WAC 388-71-0890, WAC 388-71-0895,; WAC 388-71-0931

WAC 388-71-0932

kq d kµnq d kÆ W vkz b kanSj k SadµenI n †B R p:

ElA

WAC 388-71-0985, WAC 388-71-0990, WAC 388-71-0991

WAC 388-71-1001

kq d kµnq d kÆ W vkz b kanyx g yJ n :

ElA

WAC 388-71-0973, WAC 246-12-030,

RCW 18.88B.021(1)-(2)

Si d wµnadVnSi d ti k anFz g erJ Æ w g:

WAC 388-71-0561

Page 1 of 3

IP PLANNED ACTION NOTICE TRAINING / CERTIFICATION

DSHS 07-097 LA (REV. 03/2018) Laotian

vz n tI K wgVbEc™ g kan

AGING AND LONG-TERM SERVICES ADMINISTRATION (ALTSA)

DEVELOPMENTAL DISABILITIES ADMINISTRATION (DDA)

VbEc™ g kankAtµtI Æ T J k vagwwkmaSµlz b ÏU ™ e bi Æ g EYgdU E lSÆ v nbu k ˚q n

kanƒj k ƒq n /kanyx g yJ n

Individual Provider Planned Action Notice Training / Certification

s J Æ ElA tI Æ y U Æ K wgÏU ™ e bi Æ g EYgdU E l

kankAtµtI Æ T J k vagwwkma

k q d HmaYp q k ˚wgr z d v M s i g † z n

b z n c u k q d kµn q d Sµl z b kanƒ j k ƒ q n ElA/Hl J kany x g

Washington Administrative Code (WAC) Chapter 388-71

y J n t I Æ c µep z n ef J Æ w cAm I e g J Æ w nRKt I Æ c Aeh z d vWk ElA T J k c Æ a Yeg i n VH ™ o dY

Hl J

Aging and Long Term Care Support Administration (ALTSA)

VnTanAep z n Ï U ™ e b i Æ g EYgd U E lS Æ v nb u k ˚ q n /fAn z k ganeb i Æ g EYgb q v rAb z d rAYAYav.

Developmental Disabilities Administration (DDA)

w z n n [ E m Æ n ef J Æ w cAEc ™ g VH ™ t Æ a nsabv Æ a el [ m † X n † x g E† Æ

k q m

Hl J

Department of Social and Health Services (DSHS)

Area Agency

kµl z g cA:

on Aging (AAA)

pA† i e Sd / † z d kanc Æ a Yeg i n VH ™ t Æ a nVnTanAep z n Ï™ U e b i Æ g EYgd U E lS Æ v nb u k ˚ q n ;

pA† i b z d K x n †wnef J Æ w cA† z d S z n Yakanb M r i k anl U k ˚ ™ a KwgÏ U ™ e b i Æ g EYgd U E lS Æ v nb u k ˚ q n Kwgt Æ a n.

t Æ a nb B R d ™ T J k wAn u Y adVH ™ e h z d vWkep z n Ï U ™ e b i Æ g EYgd U E lS Æ v nb u k ˚ q n ElA k q m

cAb B c Æ a Yeg i n VH ™ t Æ a nSµl z b t u k @s q Æ v omgt I Æ R d ™ e h z d vWkVnv z n t I Hl J Hl z g cak

DSHS

ElA

w I k c q n kv Æ a t Æ a nRd ™ S µer z d k q d kµn q d Kwgkanƒ j k ƒ q n /kany x g y J n t I Æ † ™ w gRd ™ e h z d

t Æ a nRd ™ T J k wAn u Y adVH ™ e h z d d z Æ g n x n odYk q m

Hl J

DSHS

AAA.

l U k ˚ ™ a Kwgk q m

cAb B

DSHS

t Æ a ncAb B S amadt I Æ c Aeh z d vWkRd ™ Y ™ w nv Æ a t Æ a n:

b B R d ™ T J k y x g y J n odYk q m

v Æ a ep z n Ï U ™ s Æ v Yy U Æ † ameh J w nfaYVnKwbeKdevlat I Æ T J k b q Æ g Rv ™ ;

Department of Health (DOH)

b B R d ™ S µer z d kanƒ j k ƒ q n t I Æ † ™ w gkanfaYVnKwbeKdevlat I Æ T J k b q Æ g Rv ™ o dYw I g †amraYrAwWdcak

kanƒj k ƒq n tI Æ † ™ w g kan

Training Partnership.

t I Æ t Æ a nb B R d ™ S µer z d Em Æ n :

kanƒ j k ƒ q n f { n Tan;

kanS j k Sadµen I n † B R p.

bB m I Ï U ™ s Æ v YyU Æ † amehJ w n Hl J kanh z b hwgt I Æ m I ˚ u n nAv u d t i t I Æ T J k wwkVH ™ o dY

y Æ a gw J Æ n @† B R pw I k El ™ v tI Æ y U Æ V nSAfabVs™ k anRd™ ElA y U Æ V nSAfabd I

DOH

t z g Swgy Æ a g.

_______________________________________________________________________________________________

kankAtµwz n n[ R d™ T J k ehz d lq g RpodYwI g †amSi d wµnad†B l q g Rpn[

k q d HmaY

Rphwd

kank Æ a veT i g w z n ecaAc q g † B l q g Rpn [ c As Æ v Yt Æ a nRd ™ H laY:

WAC 388-71-0500

WAC 388-71-1130.

kq d rAbWbtq Æ v Rp(bz n rAYaYvÆ a EmÆ n VÏEdÆ c ATJ k bq Æ g VH™ T J k ƒj k ƒq n Hl J yx g yJ n , kanYq k evx n , k q d kµn q d k Æ W vk z b ewkSany x g y J n , wJ Æ n @):

WAC 388-

71-0500; WAC 388-71-0520; WAC 388-71-0540; WAC 388-71-0551; WAC 388-71-0561;

ElA

WAC 388-71-0836; WAC 388-71-0975

WAC 388-71-0523

kq d kµnq d kÆ W vkz b kanƒj k ƒq n f{ n Tan:

WAC 388-71-0870; WAC 388-71-0875; WAC 388-71-0880; WAC 388-71-0885;

ElA

WAC 388-71-0890, WAC 388-71-0895,; WAC 388-71-0931

WAC 388-71-0932

kq d kµnq d kÆ W vkz b kanSj k SadµenI n †B R p:

ElA

WAC 388-71-0985, WAC 388-71-0990, WAC 388-71-0991

WAC 388-71-1001

kq d kµnq d kÆ W vkz b kanyx g yJ n :

ElA

WAC 388-71-0973, WAC 246-12-030,

RCW 18.88B.021(1)-(2)

Si d wµnadVnSi d ti k anFz g erJ Æ w g:

WAC 388-71-0561

Page 1 of 3

IP PLANNED ACTION NOTICE TRAINING / CERTIFICATION

DSHS 07-097 LA (REV. 03/2018) Laotian

Si d ti V nkanwu t wnKwgtÆ a n

t Æ a nm I S i d t i V nkanF z g er J Æ w gcakwµnadkanp q k ˚wg w I g †amk q d HmaY

t Æ a ncA˚ z d ˚ ™ a nkankAtµodY

s j Æ g SAt ™ w neT i g kan

WAC 388-71-0561.

DOH

y x g y J n Kwgt Æ a nRd ™ . kankAtµodY

† ™ w gT J k ˚ z d ˚ ™ a nodYÏ Æ a nkanw u t wnRpHa

DOH

DOH.

t Æ a nm I S i d t i † B l q g Rpn [ :

t I Æ c ARd ™ h z b w z d Sµen q a KwgraYrAwWdt u k @y Æ a gt I Æ T J k Vs ™ o dY

Hl J

Vnkantµkan† z d S i n KwgeK q a ec X a ;

•

ALTSA

DDA

• t I Æ c AS q Æ g ewkSaneK X a maVH ™ e p z n Hl z k Tan;

• t I Æ c AVH ™ ˚ vamVnkanF z g er J Æ w g ElA t I Æ c ASAen I f AYanef J Æ w cAVH ™ ˚ vamVnnamKwgt Æ a n; ElA

t I Æ c ASwbTamfAYanÏ U ™ t I Æ V H ™ ˚ vamSµl z b k q m

•

t Æ a nm I e vla

v z n †ampA† i t i n cakv z n t I t I Æ m I Ï q n Vs ™ k anRd ™ K wgVbEc ™ g kanVbn [ e f J Æ w cAw u t wnkankAtµw z n n [ . ef J Æ w cAh ™ w gK M e w q a kanF z g er J Æ w gcak wµnad

kanp q k ˚wg, t Æ a n† ™ w gRd ™ S q Æ g eK X a ma, YJ Æ n VH™ , Hl J S q Æ g matagEFks ˙ VbHn z g S J ˚ µh ™ w gRpHa

Office of Administrative Hearings (OAH). OAH

† ™ w gRd ™ h z b VbHn z g S J ˚ µh ™ w gfaYVn

v z n †ampA† i t i n Kwgv z n t I t I Æ m I Ï q n Vs ™ k anRd ™ K wgVbEc ™ g kanVbn [ . VbFwmSµl z b kanh ™ w gK M e w q a kanF z g er J Æ w gcakwµ

nadkanp q k ˚wgRd ™ T J k ˚ z d manµ.

tÆ a ncA†i d †B H aVÏefJ Æ w raYrAwWd

s J Æ

elkotrASz b

H™ w gkan

wq g kan

AAA

DDA

HCS

w z d Sµen q a VS Æ V nSµnvnKwgÏ U ™ e b i Æ g EYgd U E l.

Page 2 of 3

IP PLANNED ACTION NOTICE TRAINING / CERTIFICATION

DSHS 07-097 LA (REV. 03/2018) Laotian

AGING AND LONG-TERM SERVICES ADMINISTRATION (ALTSA)

˚µh™ w gKM e wq a kanFz g erJ Æ w g

Request for Hearing

wI g †am

Sµlz b kq d rAbWbkanFz g erJ Æ w gKwgkq m

Chapter 388-526

DSHS

HlJ

S q Æ g ˚µh ™ w gK M K wgt Æ a nRpHat I Æ y U Æ b Æ w nn [ :

EFks ˙ R pHaelkn [ :

OFFICE OF ADMINISTRATIVE HEARINGS (OAH)

(360) 586-6563

PO BOX 42489

OLYMPIA WA 98504-2489

K ™ a fAec X a h ™ w gK M e w q a kanF z g er J Æ w gY ™ w nv Æ a K ™ a fAec X a † ™ w gkanyakcA˚ z d ˚ ™ a n˚µ† z d S i n † B l q g Rpn [ s j Æ g T J k eh z d l q g RpodYÏAEnk

Aging and Long Care

Support Administration (ALTSA).

cq Æ g elJ w kewq a wz n nj Æ g Kwg†B l q g Rpn[ :

Hl J

kµl z g cA:

ALTSA

DDA

pA† i e Sdkanc Æ a Yeg i n VH ™ K ™ a fAec X a VnTanAep z n Ï U ™ e b i Æ g EYgd U E lS Æ v nb u k ˚ q n ;

pA† i b z d K x n †wnef J Æ w cA† z d S z n Yakanb M r i k anl U k ˚ ™ a KwgÏ U ™ e b i Æ g EYgd U E lS Æ v nb u k ˚ q n KwgK ™ a fAec X a .

Y ™ w nv Æ a k q m

Rd ™ f q b eH z n v Æ a K ™ a fAec X a :

DSHS

b B R d ™ T J k y x g y J n odYk q m

v Æ a ep z n Ï U ™ s Æ v Yy U Æ † ameh J w nfaYVnKwbeKdevlat I Æ T J k b q Æ g Rv ™ ;

DOH

b B R d ™ S µer z d kanƒ j k ƒ q n t I Æ † ™ w gkanfaYVnKwbeKdevlat I Æ T J k b q Æ g Rv ™ o dYw I g †amraYrAwWdcak

Training Partnership;

bB m I Ï U ™ s Æ v YyU Æ † ameh J w n Hl J kanh z b hwgt I Æ m I ˚ u n nAv u d t i t I Æ T J k wwkVH ™ o dY

y Æ a gw J Æ n @† B R pw I k El ™ v tI Æ y U Æ V nSAfabVs™ k anRd™ ElA y U Æ V nSAfabd I

DOH

t z g Swgy Æ a g.

KWnsJ Æ K wgtÆ a nepz n †q v fi m VSÆ b Æ w nn[

elkotrASz b KwgtÆ a n

elkKwgÏU ™ e bi Æ g EYgdU E lKwgtÆ a n

H™ w gkantI Æ t Æ a nRd™ h z b VbEc™ g kanVbn[ m acak:

AAA

DDA

HCS

KWntI Æ y U Æ K wgtÆ a nepz n †q v fi m

emJ w g

rz d

si b o˚d

T™ a HakvÆ a tÆ a nmI Ï U ™ † agHn™ a

K ™ a fAec X a cAT J k ep z n † q v EtnodY(T ™ a Hakv Æ a t Æ a ncAep z n † q v Etn† q v t Æ a newg, y Æ a S U Æ K WnpAkwbSwgETv† B R p):

KWnsJ Æ K wgÏU ™ † agHn™ a KwgtÆ a nepz n †q v fi m VSÆ b Æ w nn[

KWnelkotrASz b KwgÏU ™ † agHn™ a KwgtÆ a nepz n †q v fi m VSÆ b Æ w nn[

emJ w g

rz d

si b o˚d

tI Æ y U Æ

T™ a HakvÆ a tÆ a nmI ˚ vam†™ w gkannµkanwµnvY˚vamSAdvk

t Æ a n† ™ w gkannaYfaSa Hl J ˚vams Æ v YeHl J w y Æ a gw J Æ n Sµl z b kanF z g er J Æ w gb B

Em Æ n

b B E m Æ n

T ™ a Hakv Æ a Em Æ n , faSaHY z g Hl J kans Æ v YeHl J w EnvVdt I Æ t Æ a n† ™ w gkan

Page 3 of 3

IP PLANNED ACTION NOTICE TRAINING / CERTIFICATION

DSHS 07-097 LA (REV. 03/2018) Laotian

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DSHS Form 07-097 "Individual Provider Planned Action Notice Training/Certification (Home and Community Services)" - Washington (Lao)

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DSHS Form 07-097 "Individual Provider Planned Action Notice Training/Certification (Home and Community Services)" - Washington (Lao)

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