Form 8610, State Long-term Care Ombudsman Program Certified Ombudsman II Recommendation and Approval

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Documents

Effective Date: 11/2023

Instructions

Updated: 11/2012

 

For promotion to certified ombudsman II (CO II) status, a managing local ombudsman (MLO) or the state long-term care ombudsman (SLTCO) recommends an active certified ombudsman who has met specific requirements.

  • For certified volunteer ombudsmen, the MLO completes this form and submits it to the SLTCO.
  • For staff ombudsmen, the SLTCO completes this form.

MLO

Insert the name of the individual recommended for promotion to CO II.

Insert the name of the local ombudsman program.

After accessing OmbudsManager and reviewing other documentation in the certified ombudsman's (CO's) files, verify completion of requirements and check each box that applies. A CO must complete all requirements before recommendation for promotion to CO II.

Sign and date the document to complete your recommendation.

Submit the document by email or fax to the Office of the State Long-term Care Ombudsman for final verification by the ombudsman developer.

After the SLTCO approves the promotion and signs the form, mail the original document to the Office of the State Long-term Care Ombudsman.

SLTCO

For staff ombudsmen, the SLTCO follows the procedures for the MLO above.

In State Office Use, enter dates and other information for CO II certification and update OmbudsManager staff/user records to reflect promoted certification status. Enter the recertification month.