Delegation Order to Unlicensed Assistive Personnel (UAP) - public health oregon 2026

1. Click ‘Get Form’ to open the Delegation Order in the editor.
2. Begin by filling in the RN's name and job title in the designated fields. This identifies who is delegating the task.
3. Next, enter the UAP's name and job title. This ensures clarity on who will be performing the delegated tasks.
4. Clearly describe the nursing task being delegated. Be specific to avoid any confusion regarding responsibilities.
5. Provide a rationale for this delegation, explaining why it is necessary and beneficial for patient care.
6. Proceed through the delegation process checklist, marking 'Yes' or 'No' as appropriate for each question regarding client stability and UAP understanding.
7. Document training details including date, modules covered, and any policies discussed during training.
8. Check for competency by selecting how you assessed the UAP’s ability to perform the task safely. Include any relevant notes.
9. Ensure that both UAP and RN sign and date where indicated, confirming receipt of training and delegation.
10. Finally, submit the completed form to the UAP’s Supervisor for filing after all evaluations are complete.

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