California Department of Public Health
State of California Health and Human Services Agency
Census and Direct Care Service Hours Per Patient Day (DHPPD)
Instructions
• The information on this form must be legible, accurate and complete.
• All patients receiving nursing services and who are present in the facility during the patient day will
be counted in the patient census.
• Only direct caregivers with a nursing services assignment shall be included in the DHPPD.
• To verify this form is complete, true and accurate, the Director of Nursing or his/her designee must
sign this form.
• Do not include patient names.
• For a definition of DHPPD, census, direct caregiver, direct care service hours, or nursing services,
please see All Facilities Letter19-16.
• Note that the patient day start time is midnight. The patient day start time must be prospective,
counting forward, 12:00am (midnight) on the designated audit day and ends 23 hours, 59minutes
and 59 seconds later.
1.
Enter the date of the patient day in MM/DD/YY format.
2.
Enter the total number of licensed skilled nursing beds for the facility.
3.
Enter Patient Date Start Time (HH:MM AM/PM) format.
4.
Enter the CDPH license number for the facility.
5.
Enter the facility name.
6.
Scheduled Total Direct Care Service Hours - Enter the total direct care service hours that have
been scheduled for the patient day. Beginning Patient Census - Enter the patient census at the
patient day start time (beginning at midnight). The Scheduled DHPPD is automatically calculated
as the Scheduled Total Direct Care Service Hours divided by the Beginning Patient Census.
Scheduled Total CNA Direct Care Service Hours - Enter the total CNA direct care service hours
that have been scheduled for the patient day. The Scheduled CNA DHPPD is automatically
calculated as the Scheduled Total CNA Direct Care Service Hours divided by the Beginning
Patient Census.
7.
Record the Beginning Census at the beginning of the 24-hour patient day (12:00 a.m.) and
again at 8 hours (8:00 a.m.) and 16 hours (4:00 p.m.) after the start of the 24-hour patient day.
Throughout each shift, record admissions, discharges, transfers, and deaths or other changes in
census. In the last row, the total census at the end of each census period (Ending Census), will
automatically calculate. The Ending Census auto-populates the subsquent Beginning Census.
8.
Enter the Actual Total Direct Care Services Hours for the entire patient day. Enter the Actual
Total CNA Direct Care Service Hours for the entire patient day. The Average Patient Census is
automatically calculated as the sum of the Beginning Census of the three census periods divided
by three. The Actual DHPPD is automatically calculated as the Actual Total Direct Care Service
Hours divided by the Average Patient Census. The Actual CNA DHPPD is automatically
calculated as the Actual Total CNA Direct Care Service Hours divided by the Average Patient
Census.
9.
At the conclusion of each patient day, the Director of Nursing or his/her designee shall review the
information documented and sign the form verifying that the information is complete, true, and
correct.
2
CDPH 612 (07/19)
