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Patient Date Start Time HH MM AM/PM 3. Total Licensed Skilled Nursing Beds 4. CDPH License 5. Facility Name 6. Facility Address 7. Administrator 8. Director of Nursing/Designee 9. Estimated Direct Care Service Hours and DHPPD Beginning Patient Census Scheduled Total Direct Care Service Hours Scheduled DHPPD 10. Actual Direct Care Service Hours and DHPPD This section must be completed at the end of each 24 hour patient day. Average Actual/Final Total Direct Total CNA Care Service Hours CNA DHPPD ...

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