Certified Manual package 2015
Prepared by Glenda A. Burke, RN BS for Alternatives
2
Certified Manual package 2015
Prepared by Glenda A. Burke, RN BS for Alternatives
3
Alternatives, A Consulting and Education Service
Order Form for Manual Package
_________ Certified
_________ Non Certified (Private Duty)
Accreditation Entity Choose One
________ Community Health Accreditation Program
________ Joint Commission
________ Accreditation Commission for Health Care Inc.
PACKAGE INCLUDES:
Deposit $1250.00 to be paid with order. Remaining
balance due on delivery of the materials.
HCAF Member Yes____ No ______ HCAF ID: ________
Certified Manual package 2015
Prepared by Glenda A. Burke, RN BS for Alternatives
4
Referred directly by HCAF Yes ___ No _____
This manual is intended for one buyer and is not to be
reproduced for multiple agency sites, additional packages can be
purchased for additional sites at a discounted rate.
Agency Name: _________________________________________
DBA: __________________________________________________
Address: _____________________________________________________
Address: _____________________________________________________
Phone Number: _______________ E mail: _________________________
FAX Number: _______________ Website: __________________________
Authorized Purchaser: __________________________________________
Check Number: _______________
Certified Manual package 2015
Prepared by Glenda A. Burke, RN BS for Alternatives
5