Schedule 144
NURSING
FACILITIES
December 21, 2011
Nebraska Records Management Division
3242 Salt Creek Circle
Lincoln, NE 68504
(402) 471-2559
Updated Disposition Report instructions and address 11/2022
No changes were made to records retention
INSTRUCTIONS FOR USING THIS SCHEDULE
Records retention and disposition schedules are designed to serve as your records
management guideline for storing and disposing of agency records, regardless of the media
on which they reside, including paper, microfilm, diskettes, optical disks, CDs, DVDs, servers,
computer hard drives, etc. This schedule was written specifically for records unique to your
office and the Local Agencies General Records Schedule #24 contains those records common
to most local government agencies. This retention schedule, which is approved by the State
Records Administrator, provides your only ongoing authority to dispose of records. Listed below
are some basic procedures to follow when applying this schedule.
DISPOSING OF RECORDS
1. Check your schedules to see what the retention period is. Note: Your agency's
unique schedule will take precedence over General Records Schedule #24 for any
items which have differences in retention requirements.
2. Dispose of records that have met their retention periods. Unless there is pending or
on going, legal action, records request, or audit.
3. For records requiring a review of, or transfer to the NE State Historical Society
(State Archives), your agency is required to contact the State Archives to negotiate
the transfer. Additionally, once the records are accessioned into their collection,
they become the property of the State Archives. The State Archives may remove
selected records in accordance with standard archival practices to ensure efficient
access, organization and enduring historical value (Nebr. Rev. Stat. §82-107).
Please contact their office by calling (402) 471-4783.
4.
Complete a Records Disposition Report for the records you dispose. The Records Disposition
Report form is located on the Secretary of State Records Management website.
https://appengine.egov.com/apps/ne/sos_records_disposition_report
. This report establishes
that the destruction was performed in your normal course of business.
NON-SCHEDULED RECORDS
Contact a Records Management Specialist in Records Management to see whether the records
will fit under an item already on the schedule. If they do not, they must be retained until they are
added to the next revision of your schedule.
SCHEDULE UPDATE
It is the responsibility of each agency to periodically update their schedule. A Records
Management Specialist in Records Management can assist you with the schedule update,
which may involve adding new records series and making revisions to existing items. Keeping
your schedule current will ensure you have the ongoing authority to discard records when their
useful life has ended.
QUESTIONS
If you have any questions about these procedures, please contact your agency Records Officer
or the Records Management Specialist in Records Management. They will help you with any
questions the schedule may present, including: transferring records to the State Records
Center or microfilming records, scanning records, etc.
Records Management Division
3242 Salt Creek Circle
Lincoln, NE 68504
402-471-2559
ITEM NUMBER RECORD TITLE DESCRIPTION/EXAMPLES RETENTION REFERENCE/COMMENTS
144-001-000-000-000-000-000 ALZHEIMER'S SPECIAL
CARE DISCLOSURE ACT
Record of disclosure of services provided.
7 years after superseded
Neb. Rev. Stats. §71-
516.02(3)
144-002-000-000-000-000-000 BYLAWS AND ARTICLES
OF INCORPORATION
Permanent
144-003-000-000-000-000-000 CENSUS DATA AND
RECORDS
May include, but not limited to: count of
residents taken at the same hour each day and
other fiscal census data as needed.
10 years
175 N.A.C. Chapter
12.006.16G1
144-004-000-000-000-000-000 DEPRECIATION
SCHEDULE AND
SUPPORTING
DOCUMENTATION
Record of current equipment value for insurance
and taxation purposes.
5 years after assets are no longer in
use by provider
471 N.A.C. Chapter 12-
001.10
144-005-000-000-000-000-000 DIETARY SERVICES
May include, but not limited to: record for
amount and frequency of food ordered, food
tem
p
erature records and menus.
2 years
144-006-000-000-000-000-000 FACILITY - FIRE
PROTECTION SYSTEMS
AND HYDRANTS
May include, but not limited to inspections, test,
maintenance, valve inspections, flow drain,
pump tests and trip tests.
ORIGINAL RECORD: Life of the
system
ALL OTHERS: 1 year after next
inspection, test or maintenance
NFPA 15, Chapter 1-8
(National Fire Protection
Association)
144-007-000-000-000-000-000 FACILITY -
MAINTENANCE AND
INSPECTION
May include, but not limited to: ground, building,
equipment maintenance or test records (except
fire protection systems) and temperature charts
for room, water and refrigeration.
•See BUILDING GROUNDS
MAINTENANCE, item 024-
013
•Boiler and Elevator
inspection required every 12
months
144-008-000-000-000-000-000 FACILITY - MATERIAL
SAFETY DATA SHEET
(MSDS)
Information on each product used in a facility
and records of its use (where product used and
time frame of the use) as required by OSHA.
MSDS RECORD: After product no
longer in use
USE/TIME FRAME RECORDS: 30
years after product no longer used
29 C.F.R. §1910.1020
144-009-000-000-000-000-000 FACILITY - PROPERTY
May include, but not limited to: deeds, titles,
leases, blue prints, building plans and
specifications.
See BUILDING
CONSTRUCTION
CONTRACTS AND
RECORDS, item 024-012 or
BUILDING PLANS AND
SPECIFICATIONS, item
024-015
Supersedes Edition of 7/24/98
SCHEDULE 144
NURSING FACILITIES
12/21/2011
Retention requirements are for all records, regardless of the media on which they reside, unless otherwise noted.
Approved:December21,2011 Page1of6
ITEM NUMBER RECORD TITLE DESCRIPTION/EXAMPLES RETENTION REFERENCE/COMMENTS
144-010-000-000-000-000-000 FACILITY -
UNDERGROUND AND
EXPOSED PIPING FLOW
TESTS
Tests to determine the condition of the pipes.
ORIGINAL RECORD: Life of the
system
ALL OTHERS: 1 year after next
inspection, test or maintenance
•NFPA 25 Chapter 1-8
(National Fire Protection
A
ssociation)
•Tests done at a minimum
of 5
y
ear intervals
144-011-000-000-000-000-000 FACILITY INITIAL
LICENSE APPLICATION
AND LICENSE RENEWALS
INITIAL LICENSE: Permanent
RENEWALS: 7 years
144-012-000-000-000-000-000 HUMAN RESOURCES -
BACKGROUND CHECKS
•HIRED: See
EMPLOYMENT HISTORY
FILE, item 024-041
•NON-HIRED: See
APPLICATIONS AND
OTHER SUPPLEMENTAL
MATERIAL USED TO HIRE
AND NOT HIRE PERSONS,
item 024-004
144-013-000-000-000-000-000 HUMAN RESOURCES -
EMPLOYEE RETIREMENT
INCOME SECURITY ACT
(ERISA)
Plan records to support or validate payment of
the premiums, the number of plan participants
and calculation of certain benefits.
6 years after premium due date
29 CFR §4007.10
144-014-000-000-000-000-000 HUMAN RESOURCES -
EMPLOYMENT TAX
RECORDS
•See EMPLOYERS
QUARTERLY TAX
STATEMENT, item 024-040
•40 C.F.R. §31-6001
144-015-000-000-000-000-000 HUMAN RESOURCES -
ENDOWMENTS, TRUSTS
AND BEQUESTS
Permanent
144-016-000-000-000-000-000 HUMAN RESOURCES -
FAMILY MEDICAL LEAVE
Basic payroll and identifying employee data,
dates of FMLA leave, employee notices of leave,
correspondence regarding leave, premium
payment or disputes, and documentation of
em
p
lo
y
ee
p
olic
y
.
3 years after date of record
29 C.F.R. §825.500
144-017-000-000-000-000-000 HUMAN RESOURCES -
INSERVICE EDUCATION
RECORDS/CEU
EDUCATION RECORDS
7 years
144-018-000-000-000-000-000 HUMAN RESOURCES -
JOB DESCRIPTIONS
Superseded or obsolete
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ITEM NUMBER RECORD TITLE DESCRIPTION/EXAMPLES RETENTION REFERENCE/COMMENTS
144-019-000-000-000-000-000 HUMAN RESOURCES -
OSHA RECORDS
May include, but not limited to: OSHA 300 log,
annual summary and OSHA 301 Incident Report
and Sharps Report Log.
•See FIRST REPORT OF
ALLEGED ACCIDENT OR
OCCUPATIONAL DISEASE
OR FIRST REPORT OF
OCCUPATIONAL INJURY
OR ILLNESS, item 024-048
•29 C.F.R.
§1910.1020(d)(1)(ii)
•29 C.F.R.
§
1904.33
144-020-000-000-000-000-000 HUMAN RESOURCES -
PAYROLL/PERSONNEL
RECORDS
Payroll Records include: Name, address, date of
birth, occupation, rate of pay and weekly
compensation of each employee.
Personnel Records include: Applications,
resumes, promotion, demotion and layoff
records, and employee records dealing with
Americans with Disabilities Act (ADA) and Age
Discrimination in Employment Act of 1967.
•PERSONNEL RECORDS:
See EMPLOYMENT
HISTORY FILE, item 024-
041
•PAYROLL RECORDS:
See PAYROLL OR
PAYMENT RECORDS, item
024-061
•NON-HIRED: See
APPLICATIONS AND
OTHER SUPPLEMENTAL
MATERIAL USED TO HIRE
AND NOT HIRE PERSONS,
item 024-004
•29 C.F.R. §1602.14
•29 C.F.R.
§
1627.3 and 621
144-021-000-000-000-000-000 HUMAN RESOURCES -
STAFFING SCHEDULES
Staff work schedules for all disciplines.
7 years
144-022-000-000-000-000-000 INCIDENT/ACCIDENT
REPORTS AND LOGS
Reports of incidents involving residents, visitors
or staff giving name. May include, but not
limited to description of incident, action taken
and lo
s of re
orts.
7 years
144-023-000-000-000-000-000 LOGS
Includes any log not otherwise scheduled. May
include, but not limited to: eye wash station and
g
enerator tests.
See LOGBOOKS AND
OTHER LOGS, item 024-
056
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ITEM NUMBER RECORD TITLE DESCRIPTION/EXAMPLES RETENTION REFERENCE/COMMENTS
144-024-000-000-000-000-000 MEDICAID COST REPORT
MATERIALS
All supporting materials used to submit the
annual cost report that all providers of service
participating in the Medicaid program are
required to file. Each report covers a 12 month
period of operations based upon the provider's
accounting year. May include but not limited to:
audited financial statements, billing forms,
general journals & ledgers, audits, revenue
usage reports and voucher register.
5 years after report has been filed or
until an audit started within the 5
years has been finalized (whichever is
later)
471 N.A.C. Chapter 12-
011.10
144-025-000-000-000-000-000 MEDICARE COST
REPORT MATERIALS
All supporting materials used to submit the
annual cost report that all providers of service
participating in the Medicare program are
required to file. Each report covers a 12 month
period of operations based upon the provider's
accounting year. May include by not limited to:
audited financial statements, billing forms,
general journals & ledgers, audits, revenue
usage reports and voucher register.
MANAGED CARE PROVIDERS: 10
years after providing the service
ALL OTHER PROVIDERS: 5 years
after the closure of the cost report or
until an audit started within the 5 years
has been finalized (whichever is later)
•42 C.F.R.
§422.504(d)(2)(iii)
•42 C.F.R. §482.24(b)(1)
•Reports must be retained
in their original or legally
reproduced form
144-026-000-000-000-000-000 MEETING MINUTES AND
MATERIALS
Includes the minutes, agendas and any
information presented or complied as
supplemental materials for the meetings.
Groups may include, but not limited to
Governing Board, Resident Council, safety and
other staff committees/meetings.
•See MEETING MINUTES
AND MATERIALS, item 024-
057
•OSHA SHARPS REVIEW
MEETINGS: See NURSING
-
EXPOSURE CONTROL
PLAN MEETING (SHARPS
REVIEW - OSHA), item 144-
031
144-027-000-000-000-000-000 MOTOR VEHICLE
May include, but not limited to maintenance,
mileage and scheduling records.
1 year after vehicle is surplused
144-028-000-000-000-000-000 NURSING - DRUG
RECORDS
May include, but not limited to: controlled drug
shift counts, emergency drug box inspection
re
p
orts, dru
g
destruction and dru
g
error records.
5 years
Neb. Rev. Stat. §71-2413
144-029-000-000-000-000-000 NURSING - EXPOSURE
CONTROL PLAN
MEETING (SHARPS
REVIEW - OSHA)
Nursing staff annual review and minutes of the
meeting which reviewed the exposure control
plan that affects occupational exposure to blood
borne pathogens and use of effective safer
medical devices.
3 years
•Minutes must be kept of
this meeting
•29 C.F.R. §1910.1030
144-030-000-000-000-000-000 NURSING - INFECTION
CONTROL TRACKING
FORMS
Incidents and corrective actions related to
infractions.
2 years
42 C.F.R. §483.65
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ITEM NUMBER RECORD TITLE DESCRIPTION/EXAMPLES RETENTION REFERENCE/COMMENTS
144-031-000-000-000-000-000 NURSING - MEDICATION
AIDE
Statements of competency.
2 years
172 N.A.C. §95-010.03
144-032-000-000-000-000-000 NURSING - NURSE STAFF
SHEET
Daily nurse staffing data that is posted as
required by law.
2 years
42 C.F.R. §483.30(e)
144-033-000-000-000-000-000 PHYSICIAN
CERTIFICATION AND
RECERTIFICATION
Record of physician licensure and privileges.
5 years
144-034-000-000-000-000-000 POLICY AND
PROCEDURE MANUAL
The original record is a complete set of all the
dated policies and procedures (including all the
su
p
erseded information
)
.
ORIGINAL RECORD: Permanent
ALL OTHER COPIES: Superseded
144-035-000-000-000-000-000 RESIDENT -
CHRONOLOGICAL
ADMISSION REGISTER
Information for each resident admitted that may
include but not limited to: name of resident, date
of admission, date of birth, social security
number, admission number, gender, name(s) of
medical practitioner and dentist, date of
dischar
g
e, and destination.
Permanent
•References as 'index'
•175 N.A.C. Chapter 12-
006.16F
144-036-000-000-000-000-000 RESIDENT - CLINICAL
RECORD
Confidential clinical record of resident care and
final disposition documentation of the record.
ORIGINAL RECORD: 5 years after
resident is discharged OR expired OR 5
years after age of majority (19 years of
age) is reached (whichever is later)
DESTRUCTION REPORT: Permanent
175 N.A.C. Chapter
12.006.16D
144-037-000-000-000-000-000 RESIDENT - HIPPA
Revision to policies and procedures regarding
protected health information. May include but
not limited to: billing documentation, disclosures
of health information and record of disclosures
from electronic health payments, treatments and
health care operations.
POLICY/PROCEDURES: 6 years from
the date of its creation or last effective
date (whichever is later)
DISCLOSURES OF HEALTH
INFORMATION: 6 years after
disclosure
ALL OTHER DISCLOSURES: 3 years
after disclosure
•45 C.F.R. §164.530(j),
§164.315(b)(2) and
§164.528
•42 USC §17935
144-038-000-000-000-000-000 RESIDENT ACTIVITIES -
OUTSIDE FOOD
Records created and used to track food brought
into the facility and served at any event. May
include, but not limited to: list of foods, who
brou
g
ht it in and residents eatin
g
it.
30 days after event
144-039-000-000-000-000-000 RESIDENT ACTIVITIES
AND PARTICIPATION
May include, but not limited to: list, schedule or
calendar of activities and the participation of
residents.
2 years
Excludes records that are
part of a specific resident's
clinical record
144-040-000-000-000-000-000 SURVEY OF FACILITY
RESULTS AND OTHER
SURVEYS
Survey of Facility Results include deficiency
statements, life safety code survey, and survey
agency requirements for licensure and
accreditation, and letters from the state survey
agency or CMS (Centers for Medicare/Medicaid
Services). Other surveys may include, but not
limited to child care, human resources,
volunteer
,
etc.
FACILITY RESULTS: 5 years from the
time of survey, end of probation period,
or restriction period of any type
(whichever is longer)
ALL OTHERS: 2 years
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ITEM NUMBER RECORD TITLE DESCRIPTION/EXAMPLES RETENTION REFERENCE/COMMENTS
144-041-000-000-000-000-000 TRAINING AND DRILL
RECORDS
Staff, residents and volunteer training and drill
records. May include, but not limited to: fire,
tornado and elo
p
ement.
1 year after training or drill performed
144-042-000-000-000-000-000 WRITTEN GRIEVANCE
A
written expression of dissatisfaction which may
or may not be the result of an unresolved
com
p
laint.
7 years
471 N.A.C. Chapter 12-002
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