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Mammography and X-ray

• BHS-HFS-100; Notice to Employees PDF icon

• BHS/HFS-101; Occupational External Radiation Exposure History PDF icon

• BHS/HFS-102; Current Occuptional External Radiation Exposure PDF icon

• BHS/HFS-31; Ionizing Radiation Rules Order Form (FILLABLE FORM) PDF icon

• BHS/HFS-32; X-Ray Supplier's Quarterly Report of Installations PDF icon

• BHS/HFS-852; Application for a Radiation Shielding Plan Review (FILLABLE FORM) PDF icon

• BHS/HFS-865; Temporary Job Site Notification Form (FILLABLE FORM) PDF icon

• BHS/HFS-892; Information Required for Approval as a Mammography Physicist PDF icon

• BHS/HFS-898; Information to be Submitted for Approval to Provide the State of Michigan Curriculum for Mammography Instruction for Radiologic Technologists PDF icon

Nursing Homes and Long Term Care

• Appeal of a Notice of an Involuntary Transfer or Discharge (BHS-OPS-505) PDF icon

• BHS E-Mail Registration (Online Submission)

• BHS Health Facility Online Complaint Form

• Certificate of Appointment for Authorized Representative BHS-NHM-125 (fill-in form) PDF icon

• Change of Administrator or Director of Nursing BHS-NHM-110 (fill-in form) PDF icon

• Documentation Checklist: Process Guideline for Evaluation of Falls/Fall Risk PDF icon

• Documentation: Implementation of Interim Guidelines for Bed Rail Use PDF icon

• Equipment and Device Safety Log PDF icon

• Facility Incident Report - 24 Hours (BHS-OPS-362) DOC icon

• Facility Incident Report-24 Hours (BHS-OPS-362) Online Submission

• Facility Information Sheet (BHS-NHM-271) PDF icon

• Facility Investigation Report - 5 Working Days (BHS-OPS-363) DOC icon

• Facility Investigation Report - 5 Working Days (BHS-OPS-363) PDF icon

• Facility Involuntary Transfer/Discharge Plan Checklist (BHS-OPS-512) PDF icon

• Facility Request to Accept Evidence of Deficiency Correction In Lieu of a Revisit Following a Complaint Survey PDF icon

• Guidance in the Preparation of a Notice of an Involuntary Transfer or Discharge PDF icon

• Home Dialysis Questionnaire PDF icon

• Informal Deficiency Resolution (IDR) Process PDF icon

• Informal Deficiency Resolution Request-Level 2 (BHS-108) PDF icon

• Informal Deficiency Resolution Request-Level 2 (BHS-108e) Fill-in Form PDF icon

• Interim Guidelines for Use of Bed Rails - Facility Checklist PDF icon

• Notice of an Involuntary Transfer or Discharge (Form BHS-OPS-502) PDF icon

• Nursing 5 Day Bed Rail Monitoring PDF icon

• Nursing Home License Application-Form BHS-NHM-101 (fill-in form) DOC icon

• Patient Surety Bond BHS-NHM-126 (fill-in form) PDF icon

• Request for change in number of Certified SNF and/or NF beds- BHS-NHM-102 (fill-in form) PDF icon

• Resident Assistance Form (Example and Instructions for Facilities Handling Complaints) PDF icon

• Resident Bed Rail Consent Form BHS-NHM-104 (Fill in Form) PDF icon


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