Nurse Staffing Variance for Type A & Type B Hospitals: OHA Notification

Type A or type B hospitals may vary from the requirements of ORS 441.765 if the hospital nurse staffing committee has voted to approve the variance. Hospitals shall notify OHA of the variance through the authority's website. The notification to OHA shall include a statement signed by the cochairs of the committee, confirming that the committee voted to approve the variance. The variance becomes effective upon submission of the notification to OHA with the required signatures and remains in effect for two years. A type A or type B hospital may renew a variance or notify OHA of a new variance as provided in ORS 441.763.

Name of person completing form*

Title of person completing form*

Email of person completing form*

Phone of person completing form*

Phone

Hospital*

Select

If other, list hospital name*

New or Renewal notification*

Select all that apply

New

Renewal

Does the variance cover:*

All hospital units

Only some units

Unit(s) covered under variance*

Only list the units that are covered under this new or renewal waiver notification

Nurse Staffing Committee Direct Care Co-Chair: First & Last Name*

Nurse Staffing Committee Direct Care Co-Chair: Title*

Nurse Staffing Committee Nurse Manager Co-Chair: First & Last Name*

Nurse Staffing Committee Nurse Manager Co-Chair: Title*

Instructions before clicking submit

Once you submit the form, the system will send a copy of the responses to the email listed under "Email of person completing form". This person will receive instructions on how to send a signed copy of the notification to OHA's hospital staffing mailbox.

The variance will not be effective until OHA receives a copy of the notification signed by the Nurse Staffing Committee Direct Care Co-Chair and Nurse Manager Co-Chair.

Send me a copy of my responses

Privacy Notice|Report Abuse