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RECORD S RETEN TION AND D I SPOSI TI ON SCH ED ULEN ew Jersey H ealth Care FacilitiesD EPARTM EN T :A GEN CY #SCH ED ULE #S462000001A GEN CY REPRESEN TATI V E:PAGE #1OF30Susan GlickD I V I SI ON :T I TLE:M anager, Special Projects/ UM DN JBUREAU :PH ONE #:973-972-8609SCH EDULE A PPROVA L: Unless in litigation, the records covered by this schedule, upon expiration of their retention periods, w ill be deemed to have nocontinuing value to the State of N ew Jersey and w ill be disposed of as indicated in accordance w ith the law and regulations of the State Records Committee.This schedule w ill become effective on the date approved by the State Records Committee.A GEN CY REPRESEN TATI V E SI GN ATURED ATE:SECRETARY, STATE RECORDS COM M I TTEE SI GN ATURESusan Glick08-19-2010Karl J. NiedererRECORD SSERI ES #08-19-2010RETAI N I NRECORD T I TLE & D ESCRI PTIOND ATE:A GEN CYSRC OR CRCD I SPOSI TI ONA cknow ledgementPlease review the attached Records Retention Schedule, making any additions,deletions or changes as necessary. Once the schedule has met your satisfaction,please sign this page as the agency representative. With this signature, youacknow ledge that you have review ed and approved this schedule. Please beadvised that changes may subsequently be suggested/ made to this schedule bya panel of Records A nalysts at the State Records Center. If revisions aresuggested/ made, you w ill be notified of such. The schedule w ill then bepresented to the State Records Committee for final approval.M anagement of Electronic RecordsThis records retention schedule includes records series w hich are maintained inan electronic format. In the normal course of business, the agency w ill take thenecessary actions to ensure: hardw are and softw are maintenance, backupprocedures, security measures, and compliance w ith the rules and regulationspertaining to the maintenance of public records. A ny reference made herein tothe process of data erasure means the process of data degaussing.SRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #2OF30D I SPOSI TI ONN OTE: The State Agency General Records Retention Schedule should be consultedfor all Financial; Personnel; General A dministrative; A gency Related Policy,Legislation, and Operating Procedure; and Report and Publication records thatare maintained in common by all offices of a N ew Jersey H ealth Care Facility.EXECUTIVE OFFICES AN D GEN ERAL RECORDS0001-0000A rticles/ Certificates of IncorporationPermanentPermanent0002-0000By-Law s of the H ospital BoardPermanentPermanent0003-0000Certificate of N eed A pplication10 yrs after projectcompletionDestroy0004-0000Deeds7 yrs after transfer of titleDestroy0005-0000Employee Opinion Surveys/ Suggestions3 yrsDestroy0006-0000Financial Transaction Status Reports0007-0001Financial Transaction Status Reports (Original)3 yrsDestroy0007-0002Financial Transaction Status Reports (Copy)A s updatedDestroy00008-0000Licensure FilesIncludes: license, annual renew als, correspondence, and surveys by theDepartment of H ealth and Senior Services. N ote: License is renew ed annually.3 yrs after expirationDestroy0009-0000Organization Charts0009-0001Organization Charts (Original)PermanentPermanentSRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTION0009-0002Organization Charts (Copy)0010-0000Policy and Procedures M anuals0010-0001Policy and Procedures M anuals (Original)0010-0002Policy and Procedures M anuals (Copy)0011-0000Quality A ssurance Reports – Departmental (Copy)0012-0000Research Reports and Studies0013-0000Statistical Reports0013-0001Statistical Reports – A nnual0013-0002AGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #3OF30D I SPOSI TI ONPeriodic reviewDestroyPermanentPermanent3 yrs after updateDestroy3 istical Reports – Quarterly and M onthly3 yrsDestroy0013-0003Statistical Reports – Weekly1 yrDestroy0013-0004Statistical Reports – Daily1 monthDestroy0013-0005Statistical Reports– (Copy)Periodic reviewDestroy65 yrsDestroyH UM A N RESOURCES/ PERSON N EL0050-0000Residency Personnel FileSRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #4OF30D I SPOSI TI ON0051-0000Student Education FileIncludes: grades, evaluation, and w ork schedules, etc.65 yrsDestroy0052-0000Student A pplication Log/ Intern Register65 yrsDestroy0053-0000Residents Surgical Procedures PerformedConsists of a listing containing names of residents and procedure performedduring four (4) year residency.20 yrsDestroy0054-0000Employee M edical Records40 yrsDestroyPermanentPermanentPeriodic reviewDestroy3 yrs after updateDestroy3 yrsDestroy3 yrs after updateDestroyPermanentPermanentPLA N NING0100-0000Planning Subject FileUsed for long range planning and development of the hospital.0100-0001Planning Subject File – Plans0100-0002Planning Subject File – WorkpapersM A RKETIN G – A UXILIARY0150-0000Donor FilesInclude: name, address, and amount of donation.0151-0000N ew s Clippings and A ds0152-0000Prospect CardsConsist of index cards of prospective donors for fund raising.M A RKETIN G – PUBLIC RELA TION S0200-0000PhotographsSRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #5OF30D I SPOSI TI ON0201-0000Press ReleasesPermanentPermanent0202-0000Public Service A s0203-0001Publications (Original)PermanentPermanent0203-0002Publications (Copy)Periodic reviewDestroy3 yrsDestroy3 yrs after updateDestroy6 yrs after terminationof employmentDestroy3 yrs after updateDestroy6 yrs after terminationof employmentDestroy3 yrsDestroyM A RKETIN G – V OLUNTEER SERVICES0250-0000Sign-In Sheets0251-0000Training M aterials and H andouts0252-0000Volunteer A pplication Files – A dult and JuniorInclude: application, reference letters, interview sheet, check sheet, andUtilization Form w hich indicates position, needs, job description and placement.EDUCATION0300-0000Educational ProgramsIncludes: manuals and program outlines, etc.0301-0000Education Training FilesIncludes: R.N ., L.P.N ., Unit Secretaries and N ursing Technicians. Contains testbooklets and results.EDUCATION – I N -SERVICE EDUCA TION0350-0000Cardio – Pulmonary Resuscitation (CPR) TrainingIncludes: test results, test booklets, test result strips, and skill sheet.SRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #6OFD I SPOSI TI ON0351-0000CPR Certificate Roster3 yrsDestroy0352-0000First A id Roster3 yrsDestroy0353-0000Screening Registration FormIncludes: diabetes, hypertension, glaucoma, breast, colon-rectal and cholesterolscreens, and information release form.3 yrsDestroy6 yrs after terminationof employmentDestroyN URSING - A DMINISTRATION0400-0000N ursing Licenses (Copy)0401-0000N ursing Schedules7 yrsDestroy0402-0000Tw enty-Four H our Report3 yrsDestroy7 yrsDestroy10 yrs after final entryDestroyN URSING – A M BULATORY CA RE0450-0000A mbulance Log Slips0451-0000A mbulance Records Book/ RegisterN URSING – CEN TRA L SUPPLY0500-0000Equipment Use RecordRecords date used and by w hom.3 yrsDestroy0501-0000Steam Sterilization Control RecordIncludes: Bouse-Dick chart test, graph, load card, gas sterilizer load card, andbiological monitoring form, etc.3 yrsDestroy0502-0000Syringe and N eedle Control Record3 yrsDestroySRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENT30FORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #7OF30D I SPOSI TI ON0503-0000Syringe and N eedle Inventory Sheet1 yrDestroy0504-0000Syringe and N eedle Worksheet3 yrsDestroy0505-0000Washer/ Sterilizer Cleaning Log Sheet3 yrsDestroy3 yrsDestroyPermanentPermanentN URSING – SURGERY/ OPERA TIN G ROOM0550-0000A utoclave Graphs – Sterilization0551-0000Birth Logs0552-0000H ospital Infection Statistical report3 yrsDestroy0553-0000Infection Report Form3 yrsDestroy0554-0000Operating Room Cancellation List1 yrDestroy0555-0000Operating Room Charge Sheet (Copy)Original maintained by Finance.3 yrsDestroy0556-0000Operating Room Reservation Sheet1 yrDestroy0557-0000Operating Room Log10 yrsDestroy0558-0000Patient Record (Copy)Used to monitor patient’s progress after surgery. Original located in patient’smedical record.2 yrsDestroy0559-0000Temperature and H umidity Log3 yrsDestroySRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #8OFD I SPOSI TI ONN URSING – A NESTHESIOLOGY/ RECOVERY ROOM0600-0000A rthroscopy Video Tapes5 yrsDestroy0601-0000Crash Cart ChecklistLists: contents of each cart, date, and nurses signatures.5 yrsDestroy0602-0000Defibrillator Checklist3 yrsDestroy0603-0000Pre-Operative and Post-Operative Checklists3 yrsDestroy0604-0000Recovery Room LogIncludes minor surgery and same-day surgery.10 yrsDestroy0605-0000Weekly Duty List/ Schedule7 yrsDestroyN URSING – EM ERGENCY ROOM0650-0000Emergency Department Log and/ or Card Files3 yrsDestroy0651-0000Emergency Room Daily Statistics1 yrDestroy0652-0000M obile Intensive Care Unit A udio Tapes3 yrsDestroy5 yrsDestroy3 yrs after final entryDestroyPROFESSION A L SERVICES – L A BORA TORY0700-0000Blood Bank – Immunohematology Proficiency and Clinical Laboratory TestReports (Copy)Includes: record of transfusions and cross matches. Originals maintained inpatient medical record. M ay also include Test Requisitions0701-0000A ppointment LogSRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENT30FORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTION0702-0000Blood Bank Register0703-0000Exfoliative Cytology Reports – Pap Smears0703-0001AGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #9OF30D I SPOSI TI ONPermanentPermanentExfoliative Cytology Reports – Positive or Questionable Result50 yrsDestroy0703-0002Exfoliative Cytology Reports – N egative Result2 yrsDestroy0704-0000GraphsPrintouts indicating barbiturates, alcohol, cocaine, and opiates, etc.2 yrsDestroy0705-0000Instrument M aintenance Reports/ M achine Calibrations7 yrsDestroy0706-0000Laboratory Test Log Books7 yrs after final entryDestroy0707-0000M achine Log7 yrsDestroy0708-0000Quality Control reports – Blood Bank7 yrsDestroy0709-0000Workbooks – Urine Screening Tests2 yrsDestroyPROFESSION A L SERVICES – L A BORA TORY0710-0000Specimen RecordsIncludes: identifying information, test results and reports. A lso used for QualityControl and Proficiency Test Results0710-0001Specimen Reports – Immunohematology - Blood BankTest Reports, Test Results, and Identifying Information10 yrsDestroy0710-0002Specimen Records – Pathology Test Reports20 yrsDestroySRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #10OF30D I SPOSI TI ON0710-0003Specimen Records – General Test Reports2 yrsDestroy0711-0000Bone M arrow Reports20 yrsDestroy0712-0000Blood Bank Donor and Recipient Cards5 yrsDestroy0713-0000Blood Bank Employee Signatures, Initials and Identification Codes6 yrs after terminationof employmentDestroy0714-0000A ccession Log2 yrsDestroy0715-0000Laboratory Test Request5 yrsDestroy20 yrsDestroyPermanentPermanentPROFESSION A L SERVICES – PA TH OLOGY0750-0000A utopsy Reports (Copy)Original maintained in M edical Records.0751-0000Death Register Books0752-0000Death Slips and M ortician’s Releases7 yrsDestroy0753-0000Pathology Report on Lab Results (Copy)Original located in patient’s medical record.10 yrsDestroy10 yrs form most recentdischarge or age 23,w hichever is longerDestroy20 yrsDestroyPROFESSION A L SERVICES – PSYCH IATRY0800-0000Social Services Patient Files – N otes and Workpapers0801-0000Social Services Patient Files – Summary SheetSRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #0802-0000RECORD T I TLE & D ESCRI PTIONSocial Services Patient Files – IndexAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #11OFD I SPOSI TI ON20 yrsDestroy3 yrsDestroyPROFESSION A L SERVICES – PEDIA TRICS0850-0000N ursery Daily Statistics0851-0000Pneumogram0851-0001Pneumogram – Interpretation Report23 yrsDestroy0851-0002Pneumogram – Graph5 yrsDestroy10 yrs after most recentdischarge or age 23,w hichever is laterDestroy5 yrsDestroy10 yrs after most recentdischarge or age 23,w hichever is laterDestroyPROFESSION A L SERVICES – CA RDIOPULMONA RY0900-0000Electrocardiograms/ Echocardiograms0900-0001Electrocardiograms/ Echocardiograms – Diagnostic and Interpretation Report0900-0002Electrocardiograms/ Echocardiograms – Graphs0901-0000H olter M onitor0901-0001H olter M onitor - Diagnostic and Interpretation Report0901-0002H olter M onitor – Graph5 yrsDestroy0902-0000M achine Calibration LogLife of the instrumentplus 2 yrsDestroySRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENT30FORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTION0903-0000Outpatient M edical Charts0904-0000Work SchedulesAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #12OFD I SPOSI TI ON10 yrs after most recentdischarge or age 23,w hichever is laterDestroy3 yrsDestroy10 yrs after most recentdischarge or age 23,w hichever is laterDestroy5 yrsDestroyLife of the instrumentplus 2 yrsDestroy7 yrsDestroyPROFESSION A L SERVICES – N 01Electroencephalograms – Explanation and Interpretation Report0950-0002Electroencephalograms – Graphs0951-0000M achine Calibration Log0952-0000Work SchedulesPROFESSION A L SERVICES – D IETA RY1000-0000Cashier Tapes – CafeteriaUsed for account verifications.7 yrsDestroy1001-0000Diet Information Sheet – Daily1 yrDestroy1002-0000Dietary Instructions Log3 yrs after final entryDestroy1003-0000Food Tally – Daily Production Sheet3 yrsDestroy1004-0000Patient M eal Count – Daily3 yrsDestroySRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENT30FORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #13OFD I SPOSI TI ONPROFESSION A L SERVICES – D IA GN OSTIC AN D TH ERA PEUTIC SERVICES1050-0000Outpatient Files1051-0000Respiratory Therapy Patient Kardex Index Cards10 yrs after most recentdischarge or age 23,w hichever is laterDestroy3 yrs after mostrecent dischargeDestroyPROFESSION A L SERVICES – PH A RM ACY RECORDS1100-0000A ntibiotic Sensitivity Patterns – Graph5 yrsDestroy1101-0000Barbiturate Records5 yrsDestroy1102-0000N arcotic Books and Records5 yrsDestroy1103-0000Patient Profile Record SystemContains: patients address, name, age group, date medication is dispensed,prescription number or designation, strength and quantity of drug dispensed,initial of dispensing pharmacist, and date of refill.N .J.A .C. 13:39-9.43.5 yrs from date of last entryin the profile recordDestroy1104-0000Pharmacist/ Intern Signature and/ or Initial Identification5 yrs after terminationof employmentDestroy1105-0000Pharmacy Requisition7 yrsDestroy1106-0000Prescription Books5 yrs after last entryDestroy3 yrsDestroyPROFESSION A L SERVICES – H OUSEKEEPIN G1150-0000Daily Patient Interview FormSRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENT30FORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #14OFD I SPOSI TI ON1151-0000Daily Supervisor’s Report3 yrsDestroy1152-0000Linen Inventory3 yrsDestroy1153-0000Patient Dismissal N otice to H ousekeeping3 yrsDestroy1154-0000Project List – Work Order3 yrsDestroy1155-0000Supply Inventory3 yrsDestroy1156-0000Weekly Inspection Report3 yrsDestroy7 yrs after final settlementor paymentDestroy7 yrsDestroy7 yrs after incident, finalsettlement or paymentDestroyPeriodic reviewDestroy7 yrs after final settlementor paymentDestroy3 yrs after dischargeDestroyPROFESSION A L SERVICES – PA TIEN T M AN A GEM EN T1200-0000A ppealsH ospital costs appeals filed by patients.1201-0000Diagnosis Related Group A nalysis FilesIncludes a financial and clinical analysis of services provided.1202-0000Incident Reports1202-0001Incident Reports (Original)1202-0002Incident Reports (Copy)1203-0000Patient Complaint Files and Litigation Case File1204-0000Social Services Discharge Planning File (Copy)Includes individual patient w orksheet and referral notes. Original maintained inmedical records.SRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENT30FORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #15OF30D I SPOSI TI ONPROFESSION A L SERVICES – RA DIOLOGY1250-0000A nnual Reports of Radiation SurveysPermanentPermanent1251-0000Daily Calibration Standards Check in Does Calibrator10 yrsDestroy1252-0000Daily Check of Incoming and Outgoing M aterials2 yrsDestroy1253-0000Daily Dose Report per Patient2 yrsDestroy1254-0000Daily Flood Check – N uclear Camera Check10 yrsDestroy1255-0000Daily Radiation M onitoring Report10 yrsDestroy1256-0000Daily Radiation M onitoring Report10 yrsDestroy1257-0000Daily Radiation Survey – A rea of Injection10 yrsDestroy1258-0000Daily Survey M eter Check2 yrsDestroy1259-0000Equipment Quality Testing – M onthly Report10 yrsDestroy1260-0000Individual M onthly Badge Report10 yrs after terminationof employmentDestroy1261-0000Individual Report of Radiation Exposure (JCA H O)10 yrs after terminationof employmentDestroy1262-0000License Files – N uclear Regulatory Commission (N RC)Includes federal and state licenses required for the operation of radiationemitting equipment.10 yrs after expirationDestroySRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #16OFD I SPOSI TI ON1263-0000N uclear Radiation Technologist Certification10 yrs after expirationDestroy1264-0000Patient CardsUsed to provide an x-ray history of a patient.10 yrs after inactiveDestroy1265-0000Patient Sign-In Roster3 yrs after final entryDestroy1266-0000Register of all Radiation Producing Equipment10 yrs after disposalof equipmentDestroy1267-0000Semiannual Survey of Calibration Standards Retested3 yrsDestroy1268-0000Semiannual Survey Report of M eters Recalibrated and Re-tested3 yrsDestroy1269-0000Weekly Bar Phantom Check Report – Calibration Report3 yrsDestroy1270-0000Weekly Radiation Survey of Entire Radiology Department3 yrsDestroy1271-0000Work Schedules7 yrsDestroy1272-0000X-Ray Films5 yrsDestroy1273-0000X-Ray Interpretation (Copy)Original maintained in M edical Record.5 yrsDestroy1274-0000X-Ray Technician Certification10 yrs after expirationDestroy1275-0000Inventor of all Sealed Radioactive M aterials3 yrsDestroy1276-0000Sealed Source Records – Leak Tests3 yrsDestroySRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENT30FORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #17OFD I SPOSI TI ON1277-0000Unsealed Source Records – A rea Contamination Wipe Tests3 yrsDestroy1278-0000Survey of Radioactive M aterial Received3 yrsDestroy1279-0000Survey of Waste Generated in Controlled A reas3 yrsDestroy1280-0000N uclear M edicine Dose Calibrator – Constancy Test, Linearity Test, A ccuracyTest and Geometry Test3 yrsDestroy1281-0000N uclear M edicine Radiopharmaceutical Dosage – Dose Determination Test3 yrsDestroy1282-0000N uclear M edicine Imaging Service – Uniformity Test and Resolution Test3 yrsDestroy1283-0000N uclear M edicine Well Counter – Constancy Test3 yrsDestroy1284-0000M ammograms – X-rays and Interpretive Report(21 CFR 900.12(c)4)10 yrsDestroy1285-0000Radiation Oncology Treatment Patient Records(N .J.A .C. 8:43G-28.16 (b))2 yrs after death of patientor until patient obtains ageof 90, or for 5 yrs,w hichever is longerDestroy7 yrsDestroyFIN AN CEN OTE: The State Agency General Records Retention Schedule should be consultedfor all Financial Records that are maintained by a N ew Jersey State H ospital.1300-0000CensusStatistical reports that provide total number of admission, discharges, transfers,and deaths.1300-0001Census –A nnualSRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENT30FORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #18OFD I SPOSI TI ON1300-0002Census – M onthly and Quarterly3 yrsDestroy1300-0003Census – Weekly1 yrDestroy1300-0004Census – Daily1 monthDestroy1300-0005Census (Copy)A s updatedDestroy1301-0000Daily Bed Count3 yrsDestroyFIN AN CE – A DMISSION S/ REGISTRATION1450-0000A dmission Register/ Log3 yrsDestroy1451-0000Daily Reservation Sheets1 yrDestroy20 yrsDestroyFIN AN CE – BUDGET AN D REIM BURSEM EN TS1500-0000A nnual H ospital Rate Submission1501-0000H ospital Rate A ppeals7 yrs after settlementDestroy1502-0000M edicare Cost Reports3 yrsDestroy1503-0000M onthly Detail A nalysis Report1503-0001M onthly Detail A nalysis Report (Original)3 yrsDestroy1503-0002M onthly Detail A nalysis Report (Copy)A s updatedDestroySRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENT30FORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #19OF30D I SPOSI TI ONFIN AN CE - A CCOUNTIN GN OTE: The State Agency General Records Retention Schedule should be consultedfor all Financial A ccounting Records that are maintained by a N ew Jersey StateH ospital.FIN AN CE – PA TIEN T BILLIN G1550-0000A ssessment Reports of Patients A ccounts – M onthly Status Report3 yrsDestroy1551-0000Departmental A llow ance Reports3 yrsDestroy1552-0000M onthly A gency Paid and Open A ccount Report3 yrsDestroy1553-0000M onthly Payment Register7 yrsDestroy1554-0000M onthly Trial Balance - PatientLists all costs per patient.3 yrsDestroy1555-0000Patient Billing FileIncludes: A dmission Form (Copy), verification documentation, insurancecompany correspondence, detailed billing list, and uniform bill.7 yrs after final actionor w rite-offDestroy1556-0000Record of Refund7 yrsDestroyFIN AN CE – M A TERIALS M ANA GEM EN T/ PROCUREM EN T1600-0000Cost Containment Report – Cost Savings Report1600-0001Cost Containment Report – A nnualPermanentPermanent1600-0002Cost Containment Report – M onthly3 yrsDestroySRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #20OFD I SPOSI TI ON1601-0000Itemized Listing of Receivables1601-0001Itemized Listing of Receivables – M onthly3 yrsDestroy1601-0002Itemized Listing of Receivables – Daily1 yrDestroyTRA N SPORTA TION SERVICES1650-0000Escort A ssignment Slip2 yrsDestroy1651-0000Transport Travel Log3 yrsDestroy1652-0000Vehicle M aintenance File7 yrs after disposal ofvehicleDestroy23 yrsDestroy10 yrs after most recentdischarge or age 23,w hichever is laterDestroyM EDICA L RECORDS1700-0000Fetal M onitoring Strips1701-0000M edical Records – Inpatient/ OutpatientIncludes all disciplines1701-0001Individual Patient ChartsContains: bedside notes, admission form, medical chart, medication prescribed,emergency room report, A mbulatory Care Services Report, and all requireddocumentation according to licensing and accreditation bodies.1701-0002Discharge Summary Sheet20 yrsDestroy1701-0003M edical Records of Deceased Individuals10 yrsDestroy1702-0000Subpoenas and Related Correspondence3 yrs from final actionDestroySRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENT30FORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTIONAGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #21OF30D I SPOSI TI ONSECURITY1750-0000Daily Incident Log/ Daily Blotter1751-0000Incident Reports3 yrs after final entryDestroy3 yrsDestroy3 yrs after final entryDestroyM A INTENA NCE1800-0000A ir Conditioning/ H VA C Filter Change Log1801-0000A nnual Boiler Inspection Report3 yrsDestroy1802-0000Building Plans and ity Testing of Electrical Receptacles – A nnual3 yrsDestroy1804-0000Emergency Generator Log3 yrs after final entryDestroy1805-0000Fire Prevention Checklist1805-0001Fire Prevention Checklist – A nnual Report7 yrsDestroy1805-0002Fire Prevention Checklist – Quarterly Report3 yrsDestroy1806-0000Fire/ Electrical Safety Training ProgramsIncludes: course outlines, handouts, and brochures, etc.3 yrs after updateDestroy1807-0000Freezer Temperature Readings Log3 yrs after final entryDestroySRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #RECORD T I TLE & D ESCRI PTION1808-0000M onthly Fire Drill Report1809-0000Operating Engineer’s Daily Log1810-0000AGENCY #SCHEDULE #S462000001RETAI N I NA GEN CYSRC OR CRCPAGE #22OF30D I SPOSI TI ON3 yrsDestroy7 yrs after final entryDestroyPreventive M aintenance Duct Cleaning Report3 yrsDestroy1811-0000Quarterly Inspection Report of Operating Room Equipment3 yrsDestroy1812-0000Quarterly Sew er Cleaning Inspection Room7 yrsDestroy1813-0000Sprinkler Inspection Semiannual Report3 yrsDestroy1814-0000Trash Incineration Daily ReportConsists of: statistical report on amount of trash incinerated, boxes of needles,hazardous w aste, medical w aste, w eight and temperature.7 yrsDestroy2 yrsDestroyM EDICIN E D IVISION1850-0000Daily Consultations w ith Other DepartmentsConcerning M edication Given to Patients.1851-0000Explorations and Discharges – Records of Results of M edications y CertificatesPermanentPermanent1853-0000Student A pplications – Denied3 yrsDestroy3 yrsDestroyI N FECTION CON TROL1900-0000A ntibiotic A udit Survey ReportSRC STATE RECORDS CENTER; CRC COMMERCIAL RECORDS CENTERDEPARTMENT OF STATE – DIVISION OF ARCHIVES & RECORDS MANAGEMENTFORM CR-AA-0004 (10/89 – REV 05/2004)
RECORDS RETENTION AND DISPOSITION SCHEDULERECORD SSERI ES #AGENCY #SCHEDULE #S462000001RETAI N I NRECORD T I TLE & D ESCRI PTIONA GEN CYSRC OR CRCPAGE #23OF30D I SPOSI TI ON1901-0000Environmental Sanitation Inspection Report3 yrsDestroy1902-0000Immediate/ Infection Report Form Received From N urses/ Doctor3 yrsDestroy1903-0000Weekly Report of A ntibiotic Orders5 yrsDestroy3 yrsDestroyPermanentPermanentQuality A ssurance Investigative Case File - Patient Care7 yrs after problemis resolvedDestroyQuality A ssurance Investigative Case File – Research (Original)7 yrs after problemis resolvedDestroy3 yrs after problemis resolvedDestroy7 yrsDestroy7 yrsDestroyQUA LITY A SSURANCE1950-0000Program A ssessment/ Evaluation Reports – Periodic/ Program A udit Reports1951-0000Quality A ssurance A nnual Evaluations1952-0000Quality A ssurance Investigative Case File – Pati
RECORDS RETENTION AND DISPOSITION SCHEDULE AGENCY # SCHEDULE # PAGE # S462000 001 1 OF 30 DEPARTMENT: New Jersey Health Care Facilities AGENCY REPRESENTATIVE: Susan Glick DIVISION: TITLE: Manager, Special Projects/ UMDN J BUREAU: PHONE #: 973-972-8609 SCHEDULE APPROVAL: Unless in litigation, the records covered by this schedule, upon expiration of their retention periods, will be deemed to have no
