The form for the week of 8/9/09 must be typed and is to be completed and returned in accordance with instructions on Page 2 of the form. The administrator of the facility must certify the accuracy of the reports submitted. Either the Word or Adobe Acrobat version of the form may be completed following the instructions for that software and e-mailed as an attachment (preferred method) to: dch-bhs-quarterly-staffing@michigan.gov or mailed to the address shown below.

Note: The typed administrator's name and the date are acceptable verification when submitted as an attachment to the e-mail. The administrator of the facility must sign the form if U.S. mail is used.

INSTRUCTIONS FOR SAVING THE FORM:
Save either the Word or Adobe Acrobat version of the form from the links below.  (Be aware that the Adobe Acrobat form is a very large file and may take several minutes to load.)  Save the form to your hard drive by doing the following:
4 Click on either the Word or Adobe Acrobat form link (shown below) to open the file,
4 Left click on File from the main menu at the top of the screen,
4 Left click on Save As, and
4 Left click on Save after choosing the drive and directory in which to save the file.

INSTRUCTIONS FOR COMPLETION IN WORD:
 Open Microsoft Word on your computer and:
4 Left click on File from the main menu at the top of the screen,
4 Left click on Open and go the directory in which the form was saved, open the file, and 
4 Complete the form following the directions on Page 2.

Click here to load the Microsoft Word Quarterly Nursing Staff Report (BHS-OPS-145 Word version).

INSTRUCTIONS FOR COMPLETION IN ADOBE:
Facilities that do not have MS Word available may use the form below for the Adobe Acrobat version.  Caution:  Adobe Acrobat reports cannot be saved with data unless you are using a professional version that allows writing.  Verify that you have the latest version of the free Adobe Acrobat Reader by clicking the icon and following the instructions: 

  Upon completion of the installation, open Microsoft Word and:
4 Left click on File from the main menu at the top of the screen,
4 Left click on Open,
4 Use the drop down menu with the Files of Type box option to display "ALL Files (*.*)",
4 Highlight the file name of the blank report that has been saved and right click,
4 Click the Open with Acrobat option from the menu that displays, and
4 Complete the form following the directions on Page 2.

Click here to load the Adobe Acrobat Quarterly Nursing Staff Report  (BHS-OPS-145 Adobe version).

CONTACT INFORMATION
Michigan Department of Community Health; Bureau of Health Systems
Division of Operations; Attention: Mary Munsell
Mailing Address:  P. O. Box 30664, Lansing MI 48909
Street Address: 611 W. Ottawa Street, Lansing MI 48933
dch-bhs-quarterly-staffing@michigan.gov

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