CLINICAL LADDER FOR THE REGISTERED NURSE

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1 CLINICAL LADDER FOR THE REGISTERED NURSE Policy Type: Human Resources Policy Description: Clinical Ladder Developed: June 2009 Reference Number: Review Date: April 2012 Standard: Scope: Nursing Staff Effective Date: June, 2012 Developed By: Market Clinical Ladder Committee Retired: PURPOSE The retention of competent nursing staff is a major focus of the HCA Virginia Health System. The development of a Market Clinical Ladder for staff nurses is one approach to meet this goal. The program has been developed utilizing the Novice to Expert model applied to nursing practice by Patricia Benner. The concept of the Market Clinical Ladder is based upon the Synergy Model of Nursing which will assist in promoting and defining the most competent nurse to care for each individual patient. Patient outcomes are optimized when their characteristics and nurse competency match. The Synergy Model along with use of the Caring Model in everyday practice describes the advancement of nurses clinically focused on bedside nursing through three levels based on criteria for experience, professional practice, knowledge and skills, interpersonal relationships, commitment to patient satisfaction and leadership qualities. The levels are defined as competent, proficient and expert. The Department of Nursing continues to provide support in several ways to aid the nurse in his or her clinical advancement. Curley, M. (1998). Patient-nurse synergy: optimizing patients outcomes. American Journal of Critical Care. Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley. OBJECTIVES The objectives relating to nursing include: 1. To provide an advancement choice that encourages nurses to remain at the bedside 2. To provide a system of recognition for clinical Registered Nurses 3. To utilize nurses appropriately who are educationally prepared for different levels of performance 4. To differentiate between different levels of nursing competence The ladder s objectives for the market: 1. To provide the market with a tool for recruitment and retention 2. To motivate employees 3. To promote the improvement of quality patient care 4. To aid in the reduction of turnover rates and the expenses associated with hiring new employees PROCEDURE A. THE LEVELS The Synergy Model is the framework upon which the Clinical Ladder is based. The nurse that has advanced from Novice/Advanced Beginner may seek to apply for clinical advancement by applying for RN Level III, IV, or V. The Novice/Advanced Beginner Level is a grading tool for managers to assess when the RN is ready to obtain a higher level advancement, starting at Level III. There are minimum requirements from which all three levels are built. The nurse may submit an application for the RN Level at a level their manager must approve and must provide documentation for levels III, IV and V. 1

2 RN Level I and II Novice/Advanced Beginner The Level I RN is a new graduate or RN with little or no previous experience. He/she is enrolled in an individualized orientation program. This program provides an extended general classroom/unit orientation focusing on knowledge and skills needed to practice on the unit within this hospital. Unit orientation is individualized based on the preceptee s needs. Upon completion of their orientation period the Level I RN advances to the Level II RN. The Level II RN seeks educational programs for Clinical development appropriate to their specialized interests. The Department of Nursing provides clinical in-services and certification reviews to assist in this process. These programs will help the nurse to advance in the system, as well as accept more responsibility on their unit. Upon meeting basic requirements for the department the acting manager will guide the RN to begin the clinical ladder (see page 3 for application dates). RN Level III - Competent The Level III Nurse has at least one year experience as an RN and has developed clinical and technical skills that prepare them for an expanded role in their unit as a mentor and resource for staff and patients. They are prepared to actively participate on committees, able to utilize resources to investigate new practices and present this material to their peers. Continuing education hours will be required. At least one teaching/in-service presentation and one evidence based practice project is also required. See page 5 for requirements. RN Level IV - Proficient The Level IV RN has at least two years experience as an RN and has obtained certification in at least one area of expertise. The Level IV RN should be acting in a leadership role in their department and be prepared to accept the demands of being a preceptor, cross training, and team work (additional within one s own department). Committee involvement beyond the unit is required. The Level IV RN is expected to seek additional education and opportunities to enhance themselves as well as others within the department. See page 5 for requirements. RN Level V - Expert The Level V RN is the highest level on the Market Clinical Ladder. The Level V RN applicant has at least three years experience as an RN with education requirement of a BSN or higher and has obtained at least one certification in an area of expertise. The Level V RN has truly expanded his/her role beyond the expectations of direct patient care with an emphasis on superlative patient treatment and experience as well as active involvement in the community in which they serve. Additional teaching/in-services with evidence based practices; involvement in shared governance committees in their department and house-wide and active membership in a nursing professional organization are required for the Level V RN. Using current research this RN is also required to present evidence based projects beyond their department. See page 5 for requirements. B. ELIGIBILITY REQUIREMENTS The applicant must: RNs involved in direct patient care the majority of the time, (worked 1040 hours in the previous 12 months). Not have a written warning, final written warning or suspension within 12 months prior to letter of intent date to be eligible to apply. Employees who receive a written warning, final written warning or suspension through the portfolio review date are not eligible to be approved. Be responsible for ensuring completion of clinical ladder. Accumulate the minimum number of points: Points may be accumulated through: I. Formal education II. Experience III. Continuing education/certification/college credit (see attached Development Profile) IV. Professional development/role activities (see attached Development Profile) 2

3 An employee who feels he/she has had their eligibility for application to the clinical ladder denied by the manager due to a factor not stated in the Letter of Intent (e.g. harassment, discrimination) shall have the right to appeal the manager s decision by using the employee dispute resolution process. Assistance with this process may be obtained through the facility s Human Resources Office. C. THE APPLICATION PROCESS The applicant must first meet with the Department Director to discuss their desire to apply. Managerial approval must be given prior to the application process. The Director must sign the Intent form for each applicant. Newly hired RN s (with one year previous experience as an RN) can submit their Letter of Intent after the initial 90 days of employment with portfolio to be completed within given time frame. All application packets must be completed in full and will reflect one full year of clinician activity from June 1 st to May 31 st. Applications must be submitted in a three-ring binder notebook with dividers separating each section and must be typed. This document must have the appearance of a professional document. The committee may approve a lower clinician level if criteria for upper level are not met. D. THE REVIEW COMMITTEE The purpose of the Review Committee is to maintain consistency and quality of the system throughout the Nursing Department. The application year for HCA Virginia Health System facilities will be June 1 st to May 31 st. The Letter of Intent is due by May 31 st of the year prior to the clinician activity. Due date of clinical ladder portfolios: All hospitals May 31 st. E. THE CLINICAL NURSE ADVANCEMENT APPEAL PROCESS If the review committee denies an applicant s leveling criteria and the applicant is not in agreement, the applicant may appeal the decision. Step One: The appeal shall be submitted in writing to the review committee chair within seven (7) calendar days of the decision, and contain specific rationale for the appeal. Appeals may not be based on rationale which is not consistent with the clinical ladder policy under which the portfolio was originally submitted. No changes shall be allowed to the original portfolio prior to the conclusion of the appeal process. Step Two: The review committee chair will forward the written appeal to the Chief Nursing Officer, the Director of Human Resources, and the Director of the applicant s department. The Chief Nursing Officer will review the appeal and portfolio, and within 7 calendar days forward a decision to the committee chair whether to accept the appeal or reject the appeal. This portfolio will remain with the department director until the review committee meeting. Step Three: If the appeal is accepted by the CNO, the review committee, with the CNO and Director of HR will meet to discuss the portfolio in question. This meeting will be held within 30 days of the appeal approval by the CNO. The letter of appeal must be present with the portfolio, and the Director of Human Resources (or an HR designee) will be present as a non-partial witness. The decision of the review committee will be the final decision in the appeal process. In the event of a tie vote, the Chief Nursing Officer will cast the deciding vote. The applicant will be informed of the committee s decision within seven (7) days of the final decision. Requirements of the process and procedures have been developed by the committee and approved by the Chief Nursing Officers and Human Resources Directors. The committee will maintain utmost confidentiality with all work regarding applications and decisions made. 3

4 BONUS AWARDS Once the review committee has approved the Market Ladder portfolio bonuses will be recommended as follows: Level III - $2,000 Level IV - $3,500 Level V - $5,000 Vice President Human Resources 4

5 LETTER OF INTENT Employee Name meets the eligibility requirements, has attended all mandatory in-service training for the prior year, has a satisfactory performance evaluation and is an exemplar of all aspects of the caring model. Patient satisfaction has become an important indicator of quality care. The employee understands the importance of the Caring Model philosophy and its role in quality patient care as evidenced by incorporating the five uniquely defined concepts and behaviors in the caring literature: 1. The nurse introduces his/herself to the patients and explains role in caring for them during visit. 2. The nurse addresses the patient by name of preference. 3. The nurse spends time at the bedside with the patient to help them better understand the care they receive. 4. The nurse demonstrates empathetic behaviors and serves as a patient advocate. 5. The nurse uses HCA s mission, vision and value statements to enhance the planning of patient care. 6. The nurse has had no written warning, final warning or suspension within 12 months of this letter of intent. The employee is eligible to submit an application for the HCA Virginia Health System Clinical Ladder. Approved Declined / Reason Director/Manager Signature/Date Employee Signature/Date I am striving to obtain (circle one) Clinician Level III Level IV Level V I understand that if I do not meet the criteria for the level I am striving for, it is possible for me to receive a lower level if I fulfill those requirements. Employee Address: Attention Applicant: Complete this form and photocopy. Include a copy in your portfolio and submit a copy to your Department Director. Department Director: Place completed form in the employee s unit specific file. 5

6 HCA Virginia Clinical Ladder Basic Eligibility: 1 Current licensure 2 Director s signed Letter of Intent 3 Continuous employment either full-time or part-time 4 Absence of disciplinary actions causing written formal warnings 5 Current CPR 6 Annual evaluation meets or exceeds categories on previous evaluation 7 Involved in direct patient care (RN) 8 Complete yearly mandatory requirements for department/position (i.e. ACLS, PALS) Basic Requirements (Cannot count points for minimum basic requirements) Category RN Level III RN Level IV RN Level V Years of RN Experience 1 year 2 years 3 years In-service/Contact Hours 15 contact hours 20 contact hours 25 contact hours Deliver In-service(s) 1 per year 2 per year 3 per year Education Professional Nursing Organization Certification required Membership ONLY in a professional nursing organization required for minimum 6 months. See page Certification required and BSN or higher Membership and active participation in professional nursing organization required for minimum 6 months. See page 32. Participation in evidence based practice (EBP) Provide documentation of participation in EBP in one category. (See page 16) Provide documentation of participation in 2 EBP activities, one within and one outside your dept. ( See page 16) (See activity sheet in document) Provide documentation of participation in EBP activities, both outside your dept. (See page 16) Committees x 1 Housewide or unit x 2 Housewide or unit x 3 At least 1 must be housewide *Points Beyond Basic Requirements + 24 Additional Pts Additional Pts Additional Pts. * Minimum 50% of additional points must come from professional development portion of clinical ladder. 6

7 EDUCATION BA/BS Related 2 points BSN 3 points EXPERIENCE A. RN HCA B. Prior RN Experience C. Prior LPN yrs pts yrs yrs pts yrs pts CONTINUING EDUCATION/ CEU/COLLEGE Contact Hour\(no max) Specialized course completed (beyond requirement) 1 per C.H. 2 pts each MS Related 4 points MSN 5 points D. Prior PCT/EMT yrs pts Certified Instructor (e.g. ALS, BLS, PALS) Health Care College 3 pts each See grid below Conversion Chart Years to Points Certification 5 pts per certification A and B C and D 1-5 yrs 1 point 6-10 yrs... 2 points yrs 3 points yrs 4 points yrs 5 points 26+ yrs 6 points 1-5 yrs 0.5 point 6-10 yrs 1 point yrs 1.5 points yrs 2 points yrs 2.5 points 26+ yrs 3 points Conversion Chart: BSN course BS/BA in related field MSN 2 points per 3 credit course 1 point per 3 credit course 3 points per 3 credit course MS in related field 2 points per 3 credit course Total points: Total points: Total points: 7

8 PROFESSIONAL DEVELOPMENT MINIMUM 50% OF ADDITIONAL POINTS MUST COME FROM PROFESSIONAL DEVELOPMENT PORTION OF LADDERS HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER A. A. Evidence Based 4 points each Practice B. Teaching/In-service 8 points max per class B. C1. Hospital Councils C2. Teams/Projects D. Professional Nursing Organization 7 points max/year/council 6 points max/year/team 1 point for 1 st membership 3 points each additional membership 2 points per activity 5 points for office held C1. C2. D. E. Expanded Role 1. Charge/Team 10 points Leader 2. Clinical Coach a. complete course 2 points b. per staff or student 6 points 3. Mentor 0.5 points for each staff or student (max of 4 points) 4. Cross Training 0.5 points for 4 hours or Teamwork Level III: 2 pt max. Level IV: 4 pt max. Level V: 6 pt max. 5. Competencies 2 points 6. Process 2 points per project Improvement E1. E2a E2b E3. E4. E5. E6. F. Community Service G. Service Excellence Award Winner 1 point per 2 hours (10 points max) 1 point each (6 point max excluding bonus) F. G. H. 1 Absences points 2 1 point (Absences are Occurrences as defined in the HR Policy) H. 2 Tardiness points point H 1. H 2. Total Points 8

9 GUIDELINES FOR COMPLETING THE CLINICAL NURSE ADVANCEMENT PROFILE FOR THE REGISTERED NURSE I. Formal Education The highest academic level actually completed. II. Experience Section A: Experience at an HCA facility as a staff nurse from the date of hire Section B: Experience as a RN prior to employment at a HCA facility in an acute care setting. Experience as an Extern/Nursing Assistant, LPN or Tech prior to becoming a RN. Some nurses may have their entire RN career at a HCA facility and still qualify for credits in this area. III. Continuing Education/Certification/College Courses This component addresses areas of continuing education, college courses and national certification. Section A: (See page 13) The staff nurse should attach evidence of contact hours. Some courses offered by the hospital do not grant contact hours, but qualify for credit in the clinical advancement credits. Credit is awarded for specialty course completion beyond unit competency. Credit is awarded for instructor certification, i.e., BCLS, ACLS, PALS, TNCC and others as approved by review committee. Section B: (See page 13) Section C: (See page 13) National and state certifications will vary. If contact hours are required to maintain certification, credit is given for the certification and the credit hours. Proof of membership should be provided. College courses are those leading to advanced degree in Nursing. Only courses actually completed at the time of application will be considered. NOTE: Mandatory in-services are not applicable since they are required of all staff. Any inservice or class that is a condition of employment is not applicable, i.e., BCLS. The hospital will continue to provide all mandatory in-services and job-required certification. Staff will be responsible for further continuing education and certification. 9

10 IV. Professional Development/Role Model HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER This component has eight sections: Evidence Based Practice Teaching-Clinical Instruction or In-Services Hospital/Unit Based Councils/Short-term Teams or Project Meetings Professional Nursing Organizations Expanded Role Community Service Service Excellence Absences/Tardies Many professional activities and unit projects are explained on the forms. Department Directors will approve on a retrospective basis. Additional forms may be copied as needed. Professional Role Model gives credit to those employees who demonstrate status in regards to outstanding work attendance. (A copy of your data calendar must be submitted with your application.) 10

11 I. FORMAL EDUCATION HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER A. Place X beside the highest Nursing degree held (and a related field if applicable): Baccalaureate Degree in Nursing points... Baccalaureate Degree in Related Field * points... (i.e. Science fields, Nutrition, Psychology, Social Work) Masters Degree in Related Field * points... Masters Degree in Nursing points... (You may NOT count points for the minimum degree required for the level you are seeking) Total Points... * Attach a letter of relevance stating how degree pertains to area of practice/expertise 11

12 II. EXPERIENCE Years Points A. Years of experience at an HCA facility as an RN You must show your math i.e. you have 10 years experience you will deduct 1 year for Level 3; 2 years for Level 4; 3years for Level 5 and put the total on Line A. B. Prior healthcare experience (excluding HCA experience). 1. Total years practicing as an RN in an Acute Care setting prior to HCA employment. 2. Job specialty as an RN in a position held for greater than 2 years If in your specialty for 5 years you will put 3 on line B-2 (5-2=3) C. Past LPN/NA/Tech experience within a healthcare facility: LPN =... NA =... Tech -. D. Bonus for PCT/Nursing Assistant/EMT who continues at an HCA hospital after graduation:... Total Points For A and B For C and D 1-5 years.1 point 1-5 years.0.5 points 6 10 years.2 points 6-10 years 1 point years...3 points years points years...4 points years 2 points years 5 points years points 26+ years.6 points 26+ years.3 points Please submit verification as proof. (i.e. contact information or resume) 12

13 III. CONTINUING EDUCATION/CERTIFICATION/COLLEGE COURSES POINTS A. Contact hours (beyond basic requirements) excluding College courses and requirements as listed on job description (1 contact hour = 1 point)... (Attach verification, may include CE Direct and DDI training that has been completed within the applicants submission year) See next page for point grid. 1. Specialty course completion: (does not count toward contact hour points or if required by job description) Examples: ACLS, PALS, Chemo, PEARS, PICC and or others approved by the review committee prior to submission (Attach copy of card) (per certification) # of courses x 2 points Certified instructors: Examples: BLS, ACLS, PALS, Fetal monitoring, NRP, Child Birth Classes, Tele instructors, TNCC or others as approved by the review committee prior to submission (Attach copy of card)(per certification) # of certifications x 3 points.. (Note: classes taught can be applied towards in-services performed) B. Healthcare related college classes: Must successfully complete with a grade of C during the previous 12 months. (Attach copies of transcripts or grade reports.) points from grid next page.. C. Nationally recognized RN certification. (Attach copy of current Certification -needs CEU to maintain) (Mandatory for Level IV and V) # of certifications x5 points Total Points * PLEASE NOTE, SUBMISSION OF ORIGINAL CARD/CERTIFICATE MAY BE REQUESTED BY THE COUNCIL FOR VALIDATION. 13

14 Continuing education grid does not include mandatory CEUs for in-services, workshops, conferences 1 Contact hour = 1 point 1 CEU = 10 contact hours * College credits Bachelor degree in nursing Bachelor Degree in health related field Master degree in nursing Master degree in health related field 2 points per 3 credit course 1 point per 3 credit course 3 points per 3 credit course 2 points per 3 credit course *Per the American Nurses Credentialing Center: Each CEU equals 10 contact hours. Each CME equals 1 contact hour. Every 60 minutes of a learning activity (excluding non-instructional time such as breaks, introductions, meals and social events) equals 1 contact hour. 14

15 IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL SUMMARY A. Evidence-Based Nursing Practice Points. *Reference next page* Enter from worksheet B. Teaching Clinical Instruction or In-services Points... Enter from worksheet C1. Hospital/Unit Based Councils Points... Enter from worksheet C2. Short-term Teams or Project Meetings Points... Enter from worksheet D. Professional Nursing Organizations Points... Enter from worksheet E. Expanded Role Points... Enter from worksheet F. Community Service (Health care related or hospital sponsored) Points... Include letter of recognition Enter from worksheet G. Service Excellence/Award Winner Points... Attach copy of recognition or letter. Enter from worksheet H. Absences/ Tardiness Points. Include data calendar from manager. Enter from worksheet Total Points... A C2 points are accumulated by doing more than the basic requirements for each level. Remember that 50% of your additional points must come from the Professional Development section. 15

16 Evidence-Based Nursing Practice Activities Every RN must document participation in Evidence-Based Practice per level requirements. All of the following options must be accompanied by two evidence based references. A. Contribution of two or more evidence based articles/sources on a RELATED TOPIC for one staff education opportunity within your department (posted with sign-in sheet with header paragraph discussing relevancy to department/practice). Include copies of articles and sign-in sheet. B. Conduct a discussion using at least one current evidence-based reference. This may occur in the following settings journal club, hospital council meeting, outside your unit staff meeting; or professional organization meeting. Include the following in your documentation: a. Relevancy of topic to department/practice d. Evaluation tally sheet b. Sign-in sheet of participants e. Copy of the evidence-based article c. Objectives for the activity f. Brief personal evaluation of activity(lessons learned) C. Complete a poster that highlights current evidence-based nursing practice. Posters that are viewed outside your department require approval of the Nursing Research Council. (Credit can only be given to the principle RN involved along with one additional active participant). Include the following in your documentation: a. Relevancy of topic to department/practice e. Brief personal evaluation of activity(lessons learned) b. Copies of evidence-based sources(at least 2) f. Copy of poster via a PowerPoint file or photograph c. Sign-in sheet of viewers g. Copies of the Poster Evaluation Tool (Appendix F) d. Objectives for the poster and Poster Tally Sheet (Appendix G) D. Revise and implement a clinical policy or procedure using current evidence-based practice literature or research. Include the following in your documentation: a. Original policy or procedure b. Evidence-based sources used in the revisions (at least two) c. Department approval for unit-specific revisions or approval of the hospital s Practice Council for hospital-wide revisions. This must be done before implementation. d. Revised policy and procedure E. Develop and implement a patient education resource or edit and implement an existing patient education resource using evidence-based practice literature or research. Include the following in your documentation: a. Need for the new or revised education resource e. Original education resource (if revising) b. New or revised education resource f. Copies of evidence-based sources (at least two) c. Copies of evidence-based sources (at least two) d. Department approval for unit-specific revisions or approval of the hospital s Practice Council for hospital-wide revisions. This must be done before implementation. F. Provide staff education on a relevant topic using evidence-based practice literature or research. Include the following in your documentation: a. Relevancy of topic to department/practice d. Evaluation tally sheet b. Sign-in sheet of participants e. Copies of the evidence-based sources(at least 2) c. Objectives for the activity f. Brief personal evaluation of activity(lessons learned) Some activities are more time consuming and difficult to attain; therefore any RN may complete only one of the following to fulfill the EBP requirements of the Ladder: Completion of a research class at the college level. Transcript must be provided. Primary investigator for an IRB approved research study in progress for at least six months or completed in current year. Formal poster at a state or national conference (credit can only be given to the principle RN involved along with one additional active participant) or podium presentation outside facility. This poster must first be approved by the manager/director and/or Nursing Research Committee. Acceptance of an article for nursing publication. Level IV RNs must have at least two different EBP activities (at least one of which must be outside your department) and Level V RNs must have two different EBP activities BOTH of which expands beyond own department, and may include other facility departments (as described in B above), another HCA facility or his/her professional nursing organization (for example chapter meetings). All activities documented must occur within previous 12 months. 16

17 IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL A. Evidence-Based Nursing Practice **4 points for each additional EBP over basic requirement for level** EBP Activity Letter (from page 16) Total Points Enter Total Points, Section A. Submit one example of an evidence-based nursing practice and the outcome of this practice. 17

18 IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL A. Evidence-Based Nursing Practice **4 points for each additional EBP over basic requirement for level** EBP Activity Letter (from page 16) Total Points Enter Total Points, Section A. Submit one example of an evidence-based nursing practice and the outcome of this practice. 18

19 IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL A. Evidence-Based Nursing Practice **4 points for each additional EBP over basic requirement for level** EBP Activity Letter (from page 16) Total Points Enter Total Points, Section A. Submit one example of an evidence-based nursing practice and the outcome of this practice. 19

20 IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL B. Teaching (must be taught to a minimum of 4 people) (Submit one form per class) (Photocopy this form if you need extras) Title of Program Target Audience Length of Program Date of program Repeat Classes Objectives: The following must be included: Outline (attach) Tally Sheet (attach Appendix E) Attendance Record (attach) 1. Length of class minutes = 2 points minutes = 4 points minutes = 6 points > 119 minutes = 8 points Points Subtotal points for classes taught Total Points for teaching (20 points max per year, all-inclusive) Total points. Enter total points, Section B. 20

21 IV. HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER PROFESSIONAL DEVELOPMENT/ROLE MODEL B. Teaching (must be interactive and taught to a minimum of 4 people) Content must be expanded from EBP if same subject chosen. (Submit one form per class) (Photocopy this form if you need extras) Title of Program Target Audience Length of Program Date of program Repeat Classes Objectives: The following must be included: Outline (attach) Tally Sheet (attach Appendix E) Attendance Record (attach) 2. Length of class minutes = 2 points minutes = 4 points minutes = 6 points > 119 minutes = 8 points Points Subtotal points for classes taught Total Points for teaching (20 points max per year, all-inclusive) Total points. Enter total points, Section B. 21

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