Doh 4167-2026

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The document is a Continuing Education Credit Report from the New York State Department of Health for Nursing Home Administrators. It outlines the requirements for reporting Continuing Education (CE) credits necessary for license renewal or reactivation, including details on CE programs attended, certification of attendance, and legal implications of false reporting.

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Click ‘Get Form’ to open the doh 4167 in the editor.
Begin by entering the title of the Continuing Education (CE) program and the name of the CE program sponsor in the designated fields. Ensure that you type or print legibly for clarity.
Fill in the date(s) of attendance, along with the city and state where the program took place. This information is crucial for verifying your participation.
Indicate whether the program was a home study or internal corporate program by selecting 'Y' or 'N' in the appropriate field.
Record the approval number and approved CE hours attended for each program. Make sure to double-check these figures for accuracy.
At the bottom of each page, sign and print your name, include your NYS NHA license number, and date your certification to confirm that all reported information is accurate.

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Versions	Form popularity	Fillable & printable
2007	4.8 Satisfied (106 Votes)

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