Agency Schedule Detail

Authorization Number : 50610133

Agency Series No. : DVS-DOM-01

Status : Active

Agency Web Link :

Agency : DVS

Confidential Description :

Division : DVSOVH

Vital Description :

Section :

Record Title : Domiciliary Admission Files

Revision : 0

Record Description : All admissions documents connected with the application for admission of a potential domiciliary resident. Documents include, but are not limited to, the DD214 attached to the application, birth certificate, Form 1010SH, transfer datasheet, admission application, application for health benefits, and clinical risk agreement.

Retention Period	Retention Justification	Media Code	Method of Disposal
10 years from Resident death or discharge, unless scanned into electronic database, then dispose.	Exceeds general medical retention requirement of 6 years while allowing for disposal of paper documents.	Paper	Shred
10 years from Resident death or discharge then dispose.	Exceeds general medical retention requirement but also provides sufficient time for an audit or post death or discharge record requests.	Electronic	Delete

Approvals

Status	Name	Title	Date
Approved	Brian Peters	Records Officer	11/30/2023 11:59:01 AM
Approved	Terri Dittmar	Record Administrator	12/5/2023 7:26:19 AM
Approved	Martin Meeks	State Auditor	12/6/2023 8:33:35 AM
Approved	Fred Previts	State Archivist	12/19/2023 4:48:56 PM

Notes

Date	Reason	User