Cdph 612 2026

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4.8 out of 5

179 votes

The document outlines the procedures and requirements for reporting Census and Direct Care Service Hours Per Patient Day (DHPPD) for skilled nursing facilities in California. It includes instructions for documenting patient census, direct care service hours, and necessary signatures from the Director of Nursing or designee to verify accuracy. Key components include tracking admissions, discharges, and changes in patient census throughout a 24-hour period, as well as calculating scheduled and actual DHPPD.

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Click ‘Get Form’ to open the cdph 612 in the editor.
Begin by entering the patient date in MM/DD/YY format in the designated field.
Input the total number of licensed skilled nursing beds for your facility.
Enter the patient date start time using HH:MM AM/PM format.
Fill in your CDPH license number and facility name accurately.
For scheduled direct care service hours, enter the total hours planned for that day. The system will automatically calculate DHPPD based on your entries.
Record daily census changes at specified times (12:00 AM, 8:00 AM, and 4:00 PM) and document any admissions, discharges, or transfers during this period.
At the end of the day, input actual direct care service hours and verify all information before signing off as true and correct.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (179 Votes)
2019	4.4 Satisfied (103 Votes)
2018	4.3 Satisfied (98 Votes)
2011	4.4 Satisfied (635 Votes)

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