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Guidance for Performing Root Cause Analysis (RCA) with PIPs

Overview: RCA is a structured facilitated team process to identify root causes of an event that resulted in an undesired outcome and develop corrective actions.

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/downloads/GuidanceforRCA.pdf

Date added: August 18, 2016 - Views: 20

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RCA Form Definitions - New Jersey

RCA Form Definitions Definition Examples* Competency assessment/credentialing Lack of an appropriate staff to patient ratio which takes into account patient census and

http://www.state.nj.us/health/ps/documents/rca_defs.pdf

Date added: August 19, 2016 - Views: 1

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OPTIONALOPTIONALOPTIONAL REPLACEMENT COST ADDENDUMREPLACEMENT ...

optionaloptionaloptional replacement cost addendumreplacement cost addendumreplacement cost addendum ... cfp-rca-2 (10/93) rev. 10/12 1 of 21 of 2

https://www.cfpnet.com/FORMS/RCA%202.pdf

Date added: August 19, 2016 - Views: 1

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RETURN GOODS AUTHORIZATION (RGA) FORM - Florida...

Please complete and fax or email this form to: Returns Department (850) 644-2007 phone (850) 644-7360 fax [email protected] ITEM(S) BEING RETURNED

http://www.freac.fsu.edu/books/RGA_ATLAS.pdf

Date added: August 19, 2016 - Views: 5

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Guidance on Development of a Root Cause Analysis For Patient ...

Guidance on Development of a Root Cause Analysis For Patient Safety Reporting ... • Date and time for the event should match on Event and RCA forms.

http://www.state.nj.us/health/ps/documents/guidance_rca_0308.pdf

Date added: August 19, 2016 - Views: 3

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Claim for Compensation U.S. Department of Labor

The CA-7 also should be used to claim continuing compensation, ... (Forms and Notices): If you have a substantially limiting physical or mental impairment, ...

http://www.dol.gov/owcp/regs/compliance/ca-7.pdf

Date added: August 18, 2016 - Views: 20

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Root Cause Analysis Form Instructions

The Root Cause Analysis and Causal Factor Worksheets are mandatory. ... Microsoft Word - Root Cause Analysis Form Instructions.doc Author: rita.bates

https://www.env.nm.gov/aqb/documents/RootCauseAnalysisFormInstructions.pdf

Date added: August 18, 2016 - Views: 5

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QUALITY BASICS Root Cause Analysis For Beginners

QUALITY PROGRESS I JULY 2004 I 45 Root Cause Analysis For Beginners by James J. Rooney and Lee N. Vanden Heuvel oot cause analysis (RCA) is a process

https://servicelink.pinnacol.com/pinnacol_docs/lp/cdrom_web/safety/management/accident_investigation/Root_Cause.pdf

Date added: August 18, 2016 - Views: 2

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Root Cause Analysis (RCA) Shared Checklist

Root Cause Analysis (RCA) – Shared Checklist Event #:_____Type of Event: _____ Box completed by Pt.

http://www.health.state.mn.us/patientsafety/toolkit/rcaprocesschecklist.pdf

Date added: August 18, 2016 - Views: 3

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iPad/Tablet |Repair Information Form

iPad/Tablet |Repair Information Form In order to ensure your satisfaction with the repair process, please read and follow the instructions below.

https://hub.asurion.com/content/dam/esc/common/docs/IPadTablet%20Information(776and777).pdf

Date added: August 18, 2016 - Views: 6

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This form must be returned to CCAR for RCA Training Events ...

Dates of Recovery Coach Academy: ... Please follow this link to order RCA manuals online: http://shoprecovery.us/rca-manual/ Return completed forms to . [email protected] ...

http://ccar.us/wp-content/uploads/RCA_Training_Request_Form.pdf

Date added: August 19, 2016 - Views: 1

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BOARD OF CHIROPRACTIC MEDICINE GENERAL INFORMATION ...

board of chiropractic medicine general information/instructions registered chiropractic assistant how to apply for florida licensure ... (rca) (client: 502)

http://floridaschiropracticmedicine.gov/applications/app-rca.pdf

Date added: August 19, 2016 - Views: 1

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Maine Department of Health and Human Services

Maine Department of Health and Human Services By: ... To obtain technical assistance regarding electronic testing and transmission of MDS-RCA forms,

http://muskie.usm.maine.edu/mds/RCF_ElectronicSub.pdf

Date added: August 19, 2016 - Views: 1

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RCA Withdrawal Application - pbucc.org

Rollover Contribution Account (RCA) Withdrawal Application ... Once the Pension Boards receives the completed forms, your request will be processed accordingly.

https://www.pbucc.org/images/RCA_Withdrawal_Application_2014e.pdf

Date added: February 13, 2017 - Views: 1

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ROOT CAUSE ANALYSIS SUMMARY COVER SHEET

ROOT CAUSE ANALYSIS SUMMARY COVER SHEET List Team Members Names and RCA Roles: 1. ... (S TA) t raining and appropriate STA forms to include electrical potential

http://operatingexperience.doe-hss.wikispaces.net/file/view/MOX+Electrical+Root+Cause+Analysis+Report,+RCA-10-003+02-Sep-10.pdf

Date added: January 30, 2017 - Views: 1

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RCA transfer request - WIRLCA

RCA TRANSFER REQUEST I, _____‐RCA currently at the _____ post office, request that per:

http://www.wirlca.org/Forms/RCA%20transfer%20request%20(2).pdf

Date added: August 19, 2016 - Views: 1

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Oracle On Demand Best Practice: Root Cause Analysis

Oracle On Demand Best Practice: Root Cause Analysis Oracle best practices are based upon the INTENDED AUDIENCE IT Infrastructure Library (ITIL) framework,

http://www.oracle.com/us/products/ondemand/collateral/on-demand-root-cause-analysis-bwp-069158.pdf

Date added: August 19, 2016 - Views: 1

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RCA JUNIOR PRO CHEERLEADING REGISTRATION FORM

RCA JUNIOR PRO CHEERLEADING REGISTRATION FORM Pre-K – 7th Grade (age range of 4 – 12 years old as of July 31, 2015) Cheerleading Participation Fee: $25 each

http://www.rcaknights.org/editoruploads/files/JrPro%20Cheer%20Registration%202015-16.pdf

Date added: August 19, 2016 - Views: 1

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Root Cause Analysis Overview - NASA

When performing root cause analysis, it is necessary to look at more than just the immediately visible cause, which is often the proximate cause.

http://www.hq.nasa.gov/office/codeq/rca/rootcauseppt.pdf

Date added: August 18, 2016 - Views: 13

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RCA Cost Sharing Procedures FINAL - Rice

This form is available in the RCA forms section of the Controller’s website. Closeout At the end of the project, RCA prepares a draft of the final cost sharing

https://professor.rice.edu/images/professor/controllers/forms/RCA%20Cost%20Sharing%20Procedures_FINAL.pdf

Date added: August 19, 2016 - Views: 1

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2011 Plenary Session - A2LA-American Association for ...

2011 Plenary Session Root Cause Analysis Chris Gunning Senior Accreditation Officer. What is a Root Cause Analysis (RCA) A system of problem solving methods aimed at

http://www.a2la.org/guidance/Root_Cause_Presentation.pdf

Date added: August 18, 2016 - Views: 1

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LITTLE SAINTS NURSERY SCHOOL APPLICATION FORM

little saints nursery school application form please attach the following and tick where applicable:

http://3rca.co.za/APPLICATION%20FORM.pdf

Date added: January 24, 2017 - Views: 1

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Root Cause Analysis Report

Root Cause Analysis Report Problem Statement Focal Point 2 Fatalities When Start Date 1/31/2011 Start Time 5:00am Unique Timing After requesting that a motor be restarted

http://www.sologic.com/sites/default/files/root-cause-analysis-example-dust-explosion_FULL.pdf

Date added: August 22, 2016 - Views: 1

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Root Cause Analysis - AF

2 • Root Cause Analysis is a method that is used to address a problem or non-conformance, in order to get to the “root cause” of the problem.

http://www.au.af.mil/au/awc/awcgate/nasa/root_cause_analysis.pdf

Date added: August 18, 2016 - Views: 17

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APPLICATION GUIDELINES FOR ALL RESIDENTIAL CARE ADMINISTRATOR ...

APPLICATION GUIDELINES FOR ALL RESIDENTIAL CARE ADMINISTRATOR (RCA) APPLICANTS REQUIREMENTS TO BE ELIGIBLE FOR LICENSURE Mail your completed application and fee to:

https://secure.in.gov/pla/files/RCA_Application_Instructions.pdf

Date added: October 10, 2016 - Views: 1

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BETH DIN OF AMERICA אקירמאד ןיד תיב - Rabbis

Affiliated with the Rabbinical Council of America ... Instructions for Pruzbul Forms . ... of the loans that I have outstanding to the Beth Din of America in New ...

http://www.rabbis.org/pdfs/Pruzbul.PDF

Date added: September 27, 2016 - Views: 1

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LIGHTING CONTROL ACCEPTANCE DOCUMENT

Lighting Control Acceptance Document (Page 4 of 5) Project Name: Enforcement Agency: Permit Number: Project Address: City: Zip Code: 05.

http://www.energy.ca.gov/title24/2013standards/nonres_compliance_forms/NRCA/2013-NRCA-LTI-02-A-LightingControl.pdf

Date added: August 19, 2016 - Views: 3

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Rollover Contribution Account (RCA) Agreement Form

RCA App 09/2015 Rollover Contribution Account (RCA) Agreement Form INSTRUCTIONS Note: This application communicated your desire to establish an Annuity Plan Rollover ...

https://www.pbucc.org/images/pbucc/forms/Pension/RCA_Agreement_Form.pdf

Date added: February 13, 2017 - Views: 1

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Using Root Cause Analysis to Reduce Falls in Rural Health ...

Using Root Cause Analysis to Reduce Falls in Rural Health Care Facilities Patricia Ruddick, RN, MSN; Karen Hannah, MBA; Charles P. Schade, MD; Gail Bellamy, PhD;

https://www.ahrq.gov/downloads/pub/advances2/vol1/Advances-Ruddick_61.pdf

Date added: January 11, 2017 - Views: 1

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HealthEast Root Cause Analysis Summary

HealthEast Root Cause Analysis Summary Level of Analysis Questions/Factors involved Findings and Opportunities to Improve What happened: What departments were

http://www.health.state.mn.us/patientsafety/toolkit/rcasummaryform.pdf

Date added: August 22, 2016 - Views: 1

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Recovery Audit Contractor (RAC) Toolkit

Recovery Audit Contractor (RAC) Toolkit © 2009 AHIMA Page 9 of 65 • Staff follow-up with RAC to confirm payment of 12 cents per page for inpatient hospital records

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_044065.pdf

Date added: August 18, 2016 - Views: 11

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MINI GUIDE TO OOT CAUSE ANALYSIS

Root Cause Analysis (RCA) is a method that is used to address a problem or non-conformance, in order to get to the “root cause” of the problem.

http://www.root-cause-analysis.co.uk/images/Green%20RCA%20mini%20guide%20v5%20small.pdf

Date added: August 18, 2016 - Views: 7

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REQUEST FOR BENEFICIARY CHANGE - Aflac

REQUEST FOR BENEFICIARY CHANGE Please use blue or black ink only and print legibly when completing this form in its entirety. Keep a copy of the supporting ...

https://www.aflac.com/docs/employers/change-forms/aflac-beneficiary-change-form.pdf

Date added: December 28, 2016 - Views: 1

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Example1 Root Cause Analysis Report - Sologic RCA

Example1 Root Cause Analysis Report Focal Point: Two Fatalities Report Number: CSB: No. 2011-4-I-TN Report Date: 01/10/2012 Problem Statement

http://www.sologic.com/sites/default/files/pdf/sologic-root-cause-analysis-example-chart-report-dust-explosion-11_17.pdf

Date added: August 18, 2016 - Views: 19

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Five Whys for RCA Tool - nj.gov

Five Whys for RCA Tool Author: Robert Kane;Rosalie Kane Subject: Quality Assurance and Performance Imporvement in Nursing Homes Keywords: QAPI tools Long Term Care ...

http://www.nj.gov/education/AchieveNJ/teams/strat21/FiveWhysforRootCauseAnalysis.pdf

Date added: August 20, 2016 - Views: 2

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RETIREMENT COMPENSATION ARRANGEMENT (RCA) PART XI.3 TAX RETURN

Authorized person to contact about this tax return Area code Telephone number – Custodian's address Mailing address (if different) RCA trust's name (maximum 60 ...

http://lillicoassociates.com/info-center-cra-tax-forms-and-publications-library/t3rca.pdf

Date added: November 1, 2016 - Views: 1

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INDIANA STATE BOARD OF HEALTH FACILITY ADMINSTRATORS ...

indiana state board of health facility adminstrators application guidelines for all residential care administrator (rca) applicants requirements to be eligible for ...

https://secure.in.gov/pla/files/RCA_Application_Instructions_JR_Revised.pdf

Date added: October 25, 2016 - Views: 1

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Lien Release Forms - Contractors State License Board

Conditional and Unconditional Waiver and Release Forms Civil Code Section 3262 General Principles: No lien release is binding unless the claimant executes (signs) and ...

http://www.cslb.ca.gov/Resources/GuidesAndPublications/LienReleaseForms.pdf

Date added: August 18, 2016 - Views: 13

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eHRSSC Forms Creation of Position - SharePoint

eHRSSC Forms Instructions for Creation of a New Position. JLT 01/09/2014 ... RCA jobs must have route number placed in this instruction box. . Type in phone #

http://txnapus.sharepoint.com/Documents/eHRSSC%20%20Forms%20%20%20%20Creation%20of%20Position.pdf

Date added: August 19, 2016 - Views: 1

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ROOT CAUSE & CORRECTIVE ACTION (RCCA) - Beaver Aerospace

Root Cause Analysis and Corrective Action is a Process For: Finding the true cause(s) of events Identifying and Implementing corrective actions

http://www.beaver-online.com/portal_pdfs/RCCA_Training.pdf

Date added: August 18, 2016 - Views: 20

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RCA Joint Project Review (JPR) Application

RCA Joint Project Review (JPR) Application The 14-day Joint Project Review timeline does not start until the RCA receives this completed application, the required ...

http://wrc-rca.org/forms/RCA_JPR_Application_2016.pdf

Date added: August 19, 2016 - Views: 2

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Regulatory Commission of Alaska Filing Submission Guide

RCA Filing Submission Guide (Revised February 3, 2012) Page 2 of 6 A document is considered filed on the date it is officially received by the Commission.

http://rca.alaska.gov/RCAWeb/Documents/Help/SubmissionGuide.pdf

Date added: August 22, 2016 - Views: 1

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ISMP Community Pharmacy Template for Root Cause Analysis and ...

Community Pharmacy Template for Root Cause Analysis and Action Plan, page 6 of 12. ISMP ROOT CAUSE ANALYSIS WORKBOO FOR COMMUNITY/AMBULATOR PHARMACY

http://www.ismp.org/tools/rca/Analysis-And-Action%20Plan.pdf

Date added: August 19, 2016 - Views: 3

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Reliability-Centered Maintenance and Root Cause Analysis ...

Reliability-Centered Maintenance and Root Cause Analysis: Working Together to Solve Problems Mark Galley, Cause Mapping ...

http://thinkreliability.com/PDF/root-cause-analysis-article-rca-rcm.pdf

Date added: October 19, 2016 - Views: 2

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RCA Joint Project Review Application - wrc-rca.org

RCA Joint Project Review Application The 14-day Joint Project Review timeline does not start until the RCA receives this completed application, the required ...

http://www.wrc-rca.org/forms/WRC_RCA_JPR_Application.pdf

Date added: August 19, 2016 - Views: 1

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RCA's prenuptial agreement - Rabbis

The Beth Din of America may consider the respective responsibilities of either or both of the parties for the end of the marriage, as an ... Notarization Forms

http://www.rabbis.org/forms/Halachic%20Prenuptial%20Arbitration%20Agreement.pdf

Date added: August 19, 2016 - Views: 1

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LOS ANGELES COUNTY - ladpss.org

COUNTY OF LOS ANGELES – CalWORKs/RCA CalFresh 2013 QR 7 3 (SAR) 6 6 SAR 7 ... LOS ANGELES COUNTY Author: growuser

https://www.ladpss.org/dpss/forms_library/form.cfm?id=2486&file=TEMP%20SAR1%20LA%20(11-7-13)%20CA.pdf

Date added: February 7, 2017 - Views: 1

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RCA Member Referral Form - ccamobile.org

RCA Member Referral Form To: Executive Director Rural Cellular Association As a member of the Rural Cellular Association, an organization that provides educational

https://ccamobile.org/wp-content/uploads/2010/04/RCA-Endorsement-Letter-Forms.pdf

Date added: February 13, 2017 - Views: 1

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Root Cause Analysis of MRSA MSSA Bacteraemias and Clostridium ...

Root Cause Analysis (RCA) of MRSA/MSSA Bacteraemias and Clostridium difficile Infections (CDI) - Protocol ... Completed RCA forms filed in patients medical notes.

http://www.northerntrust.hscni.net/pdf/Root_Cause_Analysis_of_MRSA_MSSA_Bacteraemias_and_Clostridium_Difficile_Infections.pdf

Date added: August 19, 2016 - Views: 1