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APPLICATION FOR A LICENCE TO OPERATE POLICIES, PROCEDURES AND OTHER DOCUMENTATION REQUIRED Insert Name of Facility Requirements 1. Provision of monthly patient data. Confirmation that contact has been made with and that systems are in place for the submission of patient activity data as required by the Chief Health Officer via the Health Statistics Unit, Queensland Health as follows: 1.1 Submission of reports to the Chief Health Officer within 35 days after the end of the month; in accordance with Section 144, Private Health Facilities Act 1999 and Section 7, Private Health Facilities Regulation 2000. ‘The licensee must submit reports about patient identification, diagnosis and activity’. Detailed requirements are prescribed in the Queensland Hospital Admitted Patient Data Collection (QHAPDC), Health Statistics Unit Queensland Health. 1.2 Provision of Perinatal statistics data to the Chief Executive (the Director-General) within 35 days after the end of the month for every baby born in Queensland; in accordance with the Public Health Act 2005 and Public Health Regulation 2005. Detailed requirements are prescribed in the Perinatal Data Collection, Health Statistics Unit, Queensland Health. Telephone: (07) 3234 1875 Email: [email protected] Website:https://www.health.qld.gov.au/hsu/default.asp 2. Medical emergency policy including patient transfer procedures 3. Patient admission criteria 4. Patient consent procedures 5. Patient complaint procedures 6. Infection control policy 7. Medication management plan Comments 8. Quality policy 9. Storage and collection contaminated waste policy of waste, including 10. Risk management plan 11. Credentialling and clinical privileges committee terms of reference and meeting minutes which includes names of members 12. Infection Control committee meeting minutes which includes names of members 13. Proposed staff roster for each clinical area 14. Staff orientation program 15. Water risk quality management plan including initial water testing results 16. Name of quality assurance entity, date of registration and proposed date of initial certification. Management team and service providers Requirements Insert information and/or provide attachment 17. Name, details and summary of curricula vita (CV) for Chief Executive Officer/Manager of facility 18. Name, details, Australian Health Practitioner Regulation Agency (AHPRA) registration number and summary of CV for Nurse-in-Charge at the facility 19. Staff plan - List intended service providers’ names and AHPRA registration number where applicable (medical/surgical/allied health and support staff). Certificates & operational requirements Requirement (when available) 1. Local Authority Certificate of Occupancy Confirmation (provide short statement that testing has occurred) 2. Medical Gases installation compliance certificate & confirmation that testing has occurred 3. Electrical compliance certification & confirmation of testing 4. Nurse / Emergency call compliance or letter plus confirmation of testing 5. Air-conditioning certificates 6. Radiation Health compliance certificate for lead shielding installations (if applicable) 7. Medical equipment compliance statement and confirmation that the equipment has been switched on and tested and is covered under warranty APPLICATION FOR A LICENCE TO OPERATE 062016 -2- 8. 9. Sterilisers and associated equipment validation, performance qualification and commissioning statements Diagrammatic evacuation plan 10. Testing of the emergency generator (if applicable) APPLICATION FOR A LICENCE TO OPERATE 062016 -3-