Complaints 

Hospitals 

Nursing Homes and Long Term Care Units 

Freestanding Outpatient Surgical Facilities (FSOFs) 

Psychiatric Hospitals and Programs 

Health Facility Construction 

Quality Improvement Nurse Consultation 

Hospices 

Radiation Safety Section 

COMPLAINTS

OPS-700

A Citizen's Guide to Filing a Complaint Against a Health Care Facility 

Web Page

BHCS Health Facility Online Complaint Form (On-Line Submission)

BHS-OPS-361

Resident/Patient Care Complaint Form 

FEDERAL CERTIFICATION FORMS (MEDICARE)

BHCS-HFD-803

HHA Branch Questionnaire (12/12)

BHCS-HFD-804

Hospice Multi Site Questionnaire (12/12)

BHCS-HFD-150

OASIS Transmittal Application (12/12)

BHCS-HFD-805

Outpatient Physical Therapy Extension Site Questionnaire (12/12)

BHCS-HFD-826

BHCS-HFD-824

BHCS-HFD-825

BHCS-HFD-601

BHCS-HFD-152

FREESTANDING OUTPATIENT SURGICAL FACILITIES (FSOFs)

BHCS-HFD-103

FSOF State License Application (Rev. 12/12)

HEALTH FACILITY CONSTRUCTION

Forms

BHS/HFS-551

Application for Plan Review (4/5/10)

BHS/HFS-551a

General Information Regarding the Application for Plan Review (2/14/06)

Interpretive Bulletins

01-2006

PTAC Units (7/14/06)

01-2003

Minimum Illumination in Cardiac Catheterization Lab and Operating Rooms (1/27/03)

02-2003

Clear Floor Area of Cubicles in Patient Holding Areas (1/29/03)

03-2003

Clearances at Chair Stations in Patient Holding Areas (1/29/03)

04-2003

Locations of Hand Wash Sinks in Isolation Anterooms/Vestibules (1/29/03)

05-2003

Emergency Department, Cubicle Sizes (1/29/03)

06-2003

Dialysis Service, Cubicle Sizes (1/29/03)

07-2003

Electrically Operated Hand Washing Faucets (1/29/03)

09-2003

Lamp Protection (1/29/03)

10-2003

Patient Window View, Unobstructed (1/29/03)

11-2003

Biological Safety Cabinets (Hoods) Used for Cytotoxic Drug Preparation (3/5/03)

01-2004

Energy Recovery Devices in HVAC Systems (Heat/Desiccant Wheels, Plate Exchangers) (2/3/04)

BHS-HFS-510

Eyewash/Drench Shower Bulletin (9/10/08)

Publications

BHS-HFS-556

1998 Minimum Design Standards for Health Care Facilities (6/9/10)

BHS-HFS-557

2007 Minimum Design Standards for Health Care Facilities in Michigan (4/5/10)

BHS-HFS-558

Baseline Survey Overview (6/13/07)

BHS-HFS-559

Clarification for Installation and Cleaning of Furniture and Equipment in Health Care Facilities (4/5/10)

BHS-HFS-560

Clarification Requirements for Disinfection & Testing of Water Supply Lines (12/11/08)

BHS-HFS-561

Guidelines for Use of Portable Air Filtration Systems in Healthcare Facilities (10/5/04)

BHS-HFS-554

Healthcare Facility Projects: Project Planning to Opening Survey Recommendations (7/31/08)

BHS-HFS-562

Hospice Residence (Inpatient) (4/5/10)

BHS-HFS-563

Hospital Water Supply Requirements (4/5/10)

BHS-HFS-564

Illumination for Health Care Facilities (8/2/04)

BHS-HFS-517

MDCH Requirements for Emergency Fuel for Hospitals (1/23/08)

BHS-HFS-565

Protection of Essential Patient Care Functions During Construction Projects (4/5/10)

BHS-HFS-550

Recommendations for Developing an Operational Narrative for Health Care Facilities (4/5/10)

BHS-HFS-566

Recommendations for Development of an ESRD (4/5/10)

BHS-HFS-553

Recommendations for the Submission of Plans and Specifications for Health Care Facilities (6/9/10)

BHS-HFS-567

Safe Handling and Disposal of Cytotoxic Drugs (4/5/10)

BHS-HFS-568

Ventilation Primer for Health Care Facilities (4/5/10)

HOSPICE

BHCS-HFD-107

Hospice State License Application (12/12)

BHCS-100-A

Hospice Licensure Appendix (3/13)

BHCS-HFD-100A1

Hospice Licensure Exemption Appendix (3/13)

HOSPITALS

BHCS-HFD-100

Hospital State License Application (3/13)

NURSING HOMES

Administrative Links for Nursing Homes

Assistance in Feeding Residents 

Web Page

BHS E-Mail Registration Form Online Submission

BHCS-LTC-125

Certificate of Appointment for Authorized Representative 

BHCS-LTC-110 

Change of Administrator or Director of Nursing 

BHCS-LTC-362

Facility Incident Report - 24 Hours  (Online Submission)

BHCS-LTC-271

Facility Information Sheet 

BHCS-LTC-363

Facility Incident Report - 5 Working Days  (Online Submission)

BHCS-LTC-325

Facility Request to Accept Evidence of Deficiency Correction (In Lieu of a Revisit) (9/11/08)

BHCS-LTC-101

Application for Nursing Home License 

BHCS-LTC-326

Plan of Correction Instructions 

BHCS-LTC-145

Quarterly Nursing Staff Report and Instructions (Fill-In Form)

BHCS-LTC-102

Request for Change in Number of Certified SNF and/or NF Beds 

BHS-106

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

BHS-NHM-104

Resident Bed Rail Consent Form (10/11)

BHS-109

Scope and Severity Grid

BHCS-LTC-126

Surety Bond for Patient Trust Funds Held by a Nursing Home 

Informal Deficiency Review Links

BHS-107

Informal Deficiency Review (IDR) Process

BHS-108

Informal Deficiency Review Request - Level 2 

BHS-108e

Informal Deficiency Review Request - Level 2 (Fill-in Form)

Involuntary Transfer or Discharge Links

BHCS-LTC-505

Appeal of a Notice of an Involuntary Transfer or Discharge 

BHCS-LTC-512

Facility Involuntary Transfer/Discharge Plan Checklist 

BHCS-LTC-511

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

BHCS-LTC-502

Notice of an Involuntary Transfer or Discharge 

Michigan Operations Manual (MOM)

PSYCHIATRIC HOSPITALS AND PROGRAMS

BHCS-HFD-100B

Psychiatric Program License Application Appendix B (3/13)

BHCS-HFD-100B1

Psychiatric Program Professional Staff Report Appendix B-1 (3/13)

BHCS-HFD-820

Psychiatric State License Application (12/12)

BHCS-HFD-823

Psychiatric Staffing Report (12/12)

BHCS-HFD-1036

Psychiatric Death Incident Report (12/12)

QUALITY IMPROVEMENT NURSE PROGRAM

Clinical Process Guidelines (CPG)

Web Page

Acute Change Of Condition (ACOC) (10/4/04)

Web Page

Altered Nutritional Status (11/8/05)

Web Page

Behavior Management and Antipsychotic Medication Prescribing (2/13/04)

Web Page

Depression (11/8/06)

Web Page

End-of-Life Care (Rev. 2/13/04)

Web Page

Evaluation of Falls/Fall Risk (Rev. 2/13/04)

Web Page

Heart Failure (10/9/07)

Web Page

Maintaining Hydration and Electrolyte Balance (11/8/05)

Web Page

Medication Management and Reduction of Adverse Drug Reactions (Rev. 2/13/04)

Web Page

Pain Management (2/13/04)

Web Page

Prevention and Management of Pressure Ulcers (2/24/03)

Web Page

Urinary Incontinence (4/6/05)

Resources 

Web Page

1999 Food Code Presentation (2/01)

Web Page

Hyperthermia (7/01)

Web Page

Hypothermia (11/00)

Web Page

Joint Provider/Surveyor Trainings

Web Page

Prevention of Wandering From Long-Term Care Facilities (2/02)

Web Page

Scabies Prevention and Control Manual (6/05)

Web Page

There is Something About "Activities" (6/06)

Web Page

Use of Bedrails in Long Term Care Facilities (4/1/01)

RADIATION SAFETY SECTION

Computed Tomography (CT) 

BHCS-HFS-110 

Guidance for CT Rules (11/12)

BHCS-HFS-111 

Reporting Guideline: Example Format for Reportable CT Medical Events (11/12)

BHCS-HFS-112 

Information Required for Approval of Initial Qualifications for a CT Medical Physicist (11/12)

Information

BHCS-HFS-852

Application for a Radiation Shielding Plan Review (11/12) [Fill In Form]

BHCS-HFS-879

Gonad Shadow Shielding (11/12)

BHCS-HFS-869

Guidelines for Analytical X-Ray Equipment Operating Procedures and Operator Training (11/12)

BHCS-HFS-108

Registration Conditions for Electronic Brachytherapy (11/12)

BHCS-HFS-846

Lead Supplier's List (11/12)

BHDS-HFS-880

Patient Radiation Exposure Information (11/12)

BHCS-HFS-107

Hand-Held Portable Dental X-Ray Systems (11/12)

BHCS-HFS-870

BHCS-HFS-800

Video Display Terminals (VDT's) and Ionizing Radiation (11/12)

BHCS-HFS-32

X-Ray Supplier's Quarterly Report of Installations (11/12)

Job Site Notifications

BHCS-HFS-865

Temporary Job Site Notification Form (11/12) [Fill In Form]

Mammography

BHCS-HFS-116

Guidance for Mammography Rules (4/13) 

BHCS-HFS-801

Suggested Procedure for Calculation of New Aim Value During Film Crossover for Processor Quality Assurance Films (11/12)

Radiation Dosimetry

BHCS-HFS-102

Current Occupational External Radiation Exposure (11/12)

BHCS-HFS-101

Occupational External Radiation Exposure History (11/12)

BHCS-HFS-837

Companies Providing Personnel Radiation Monitoring Services (11/12)

BHCS-HFS-114

Direct Ion Storage Dosimeters (11/12)

BHCS-HFS-103

Dosimetry for Analytical and Industrial Radiographic X-ray Machines (11/12)

BHCS-HFS-104

Dosimetry for Dental X-ray Machines (11/12)

BHCS-HFS-105

Dosimetry for Fluoroscopy and Other X-Ray Procedures Requiring the Use of Protective Aprons (11/12)

BHCS-HFS-106

Dosimetry for Physicians Who Operate X-ray Equipment in Private Practices (11/12)

BHCS-HFS-113

Dosimetry for Bone Densitometry X-ray Machines (11/12)

BHCS-HFS-860

Reporting Guideline - Example Format for Excessive Radiation Dose Reports (11/12)

Registration

BHCS-HFS-31

Ionizing Radiation Rules Order Form (11/12) [Fill In Form]

Required Posting in Each X-ray Facility

BHCS-HFS-100

Notice to Employees (11/12)