Form 8588 - Nursing Supervision For Unlicensed Assistive Personnel (Uap) Form
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1Texas Department of Aging
Form 8588
and Disability Services
October 2011
Nursing Supervision For Unlicensed Assistive Personnel (UAP)
Individual’s Name
Today’s Date/Frequency of Supervision
Describe changes since last visit:
Delegated tasks as described in the nursing care instructions observed today:
Other care instructions monitored today:
Additional training/reinforcement provided:
Client satisfaction with care, if assessed:
Unlicensed Assistive Personnel
Print Name
Signature
Date
Only complete if RN personally supervised
LVN Supervision Initials
Continued Competency RN initials
Delegation Revoked RN initials
RN
Print Name
Signature
Date
LVN
Print Name
Signature
Date
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