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2019 Annual Certification for Renaissance SNF Privileges

Dear Colleague,

The District of Columbia Department of Health Regulations for Nursing Facilities requires annual "free from communicable diseases" certification for practitioners who attend patients in this environment. You currently hold privileges for Sibley's Renaissance Unit and to meet this requirement we are asking you to complete a quick attestation.

As an alternative to the attestation, you may provide documentation of having a PPD placed and read. The reading should have occurred after April 1, 2019. Please fax the document to the Medical Staff Office at 202.537.4965 or email to

Documentation must be received by July 30, 2019. Failure to certify, may result in voluntary resignation of Renaissance privileges.

Should you determine that Renaissance privileges are no longer needed, you may voluntarily resign these privileges. Please email with this notification.

Thank you for your assistance in meeting this regulatory requirement.

James Bulen, M.D. J.D.
Medical Director, Renaissance SNF

D. Elise Miller, M.S.N., N.H.A., R.N.
Administrator, Renaissance SNF

Attestation Form

DC DOH Municipal Regulations for Nursing Facilities §3207(h) requires facilities to: "Ensure that attending medical professionals who treat residents in the facility have …..Initial and annual certifications of their freedom from communicable disease." Symptoms associated with communicable diseases may include persistent cough, coughing bloody sputum, unexplained weight loss, fever/chills, loss of appetite, night sweats, shortness of breath, chest pain.