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.

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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
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
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
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
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
30
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
30
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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