Home Health Forms
We have taken the headache out of searching and creating the necessary forms to successfully run a home health company.
I want to thank you for the excellent service and the professional policy manual. You saved me and my staff hours of work!
Melinda F.
Jupiter, FL
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L&C Policy and Procedure Manual
The Policy and Procedure Manual is the heart of all Home Health Agencies as well as the first item Surveyors want to review.
Does your manual
follow the Medicare Conditions of
Participation?
Does your manual follow CHAP, JCAHO, or ACHC accreditation standards?
Ours do! We even crosswalk to the accreditation body of your choice as well as to your state regulations.
Our survey
proven P&P manual will allow
you to take care of your
patients, rather than spend
your valuable time
researching rules and
regulations.
For companies seeking Medicare Reimbursement you are required to
submit policies to the Office of Civil Rights for review. Our Civil Rights, Section 504, and
Non Discrimination Polices will have your company covered.
| Table of Contents | Joint Commission |
| Table of Contents | CHAP |
| Table of Contents | ACHC |
Policy and Procedure Manual
List of Polices with PDF Samples Linked Below
| ADMINISTRATIVE | |
| 1.001.1 | Definition of Organization |
| 1.001.2 | Mission Statement and Philosophy |
| 1.002.1 | Services Offered |
| 1.003.1 | Service Area |
| 1.004.1 | Payment for Services |
| 1.004.2 | Fee Schedule |
| 1.005.1 | Hours of Operation |
| 1.006.1 | Administrative Control/Governing Body |
| 1.006.2 | Ethics Committee |
| 1.007.1 | Professional Advisory Committee (if applicable) |
| 1.008.1 | Annual Evaluation |
| 1.009.1 | Admission Criteria |
| 1.009.2 | Face to Face Encounter |
| 1.010.1 | Discharge/Transfer from Service |
| 1.011.1 | Contingency Plan |
| 1.011.2 | Agency Closure Procedures |
| 1.012.1 | Backup Coverage of Services |
| 1.013.1 | Business Associate Contract |
| 1.014.1 | Anti Fraud Program |
| 1.016.1 | Professional Standards & Principles |
| 1.017.1 | Financial Records |
| 1.017.2 | Financial Planning |
| 1.017.3 | Capital Expenditures |
| 1.018.1 | Services Provided under Contract |
| 1.019.1 | Research Activities/Investigational Studies |
| 1.020.1 | Public Disclosure |
| 1.020.2 | Disclosure to Licensing Authority |
| 1.020.3 | Change of Ownership or Administrative Control |
| 1.020.4 | Plan of Correction |
| 1.021.1 | Information Management |
| HUMAN RESOURCES | |
| 2.001.1 | Reasonable Accommodations |
| 2.002.1 | Personnel Records |
| 2.002.2 | OIG Excluded List |
| 2.002.3 | Employment References |
| 2.002.4 | Time Records |
| 2.003.1 | Selection of Personnel |
| 2.003.2 | Classification of Personnel |
| 2.003.3 | Volunteers |
| 2.003.4 | Ethics |
| 2.003.5 | Employee Dress Code |
| 2.003.6 | Employee Health Assessments |
| 2.004.1 | Payday |
| 2.005.1 | Benefits & Wages |
| 2.006.1 | Confidentiality |
| 2.007.1 | Orientation & Staff Development |
| 2.008.1 | Policy & Procedure Agreement |
| 2.009.1 | Competency Evaluation |
| 2.010.1 | Cell Phone and Texting |
| 2.011.1 | Cultural Diversity |
| 2.013.1 | Performance Evaluation |
| 2.014.1 | Employee Discipline |
| 2.015.1 | Termination/Separation of Employment |
| 2.016.1 | Employee Grievances |
| 2.017.1 | Smoking |
| 2.021.1 | Professional Peer Review |
| 2.022.1 | Professional Reporting |
| 2.023.1 | Drug Testing |
| 2.024.1 | Conflict of Interest |
| 2.025.1 | Knowledge/Resource Center |
| RIGHTS, RESPONSIBILITIES, ETHICS | |
| 3.001.1 | Client Conduct, Responsibility & Rights |
| 3.001.2 | Non Discrimination |
| 3.001.3 | Program Accessibility |
| 3.002.1 | Solicitation/Distribution for Referrals |
| 3.003.1 | Patients Complaints & Grievances |
| 3.004.1 | Reporting Abuse, Neglect, or Exploitation |
| 3.005.1 | Criminal History Checks |
| 3.005.2 | Employee Misconduct Registry |
| 3.005.3 | National Sex Offender Registry |
| 3.006.1 | Out-of-Hospital Do Not Resuscitate Order |
| 3.007.1 | Advanced Directives |
| 3.007.2 | Declaration for Mental Health Treatment |
| 3.009.1 | Coordination of Client Care |
| 3.010.1 | Advance Beneficiary Notice (ABN) |
| 3.010.2 | Home Health Change of Care Notice (HHCCN) |
| 3.011.1 | Patient Privacy Rights |
| 3.012.1 | Facilitating Communication |
| 3.013.1 | After Hours Care |
| 3.014.1 | Generic & Expedited Review Process |
| PATIENT INFORMATION | |
| 4.001.1 | Security of Clinical Information |
| 4.002.1 | Retention of Clinical Records |
| 4.003.1 | Timeliness of Entries in Clinical Record |
| 4.003.2 | Client Records |
| 4.004.1 | Physician Orders/Plan of Care |
| 4.004.2 | Physician Signatures |
| 4.004.3 | Physician Delegation |
| 4.004.4 | Physician Verification |
| 4.004.5 | RN Delegation |
| 4.005.1 | Clinical Record Review/Quarterly Review |
| 4.006.1 | Abbreviations |
| 4.007.1 | Prohibition on Transporting Patient |
| 4.008.1 | Data Entry/Transmission OASIS Info |
| 4.009.1 | Medication Profile |
| 4.009.2 | Medication Administration Record |
| 4.009.3 | Medication Storage |
| 4.009.4 | Emergency Medication |
| 4.009.5 | Medication/Prescriptions Orders |
| 4.009.6 | Confused Drug Names |
| 4.009.7 | Administration of Blood |
| 4.009.8 | Adverse Drug Reactions |
| 4.009.9 | Trasporting Vaccinations |
| 4.010.1 | Medication Reminding |
| NON-CLINICAL | |
| 5.001.1 | Billing |
| 5.001.2 | Referrals |
| 5.001.3 | Medical Supplies |
| 5.002.1 | Verification of Primary Payor |
| 5.003.1 | OASIS Corrections |
| 5.004.1 | Staffing Issues |
| 5.005.1 | Faxing |
| 5.006.1 | Protected Health Information Password/Usernames |
| 5.007.1 | Red Flag Rules |
| CLINICAL | |
| 6.001.1 | In Service Education |
| 6.002.1 | Patient Education |
| 6.004.1 | Wound Care Management |
| 6.006.1 | Pain Management |
| 6.011.1 | Reporting Emergencies in the Home |
| 6.012.1 | Cardiopulmonary Resuscitation (CPR) |
| 6.014.1 | Sharp Debridement of non viable tissue |
| 6.015.1 | Clinical Procedures |
| 6.016.1 | Care Planning |
| 6.017.1 | RN Pronouncement |
| 6.019.1 | Assessment of Patients (OASIS) |
| 6.020.1 | Nurse Supervision |
| 6.021.1 | Certified Nursing Aide |
| 6.022.1 | Physical Therapy Services |
| 6.022.2 | Physical Therapy Evaluation |
| 6.023.1 | Medical Social Worker |
| 6.023.2 | Medical Social Worker Evaluation |
| 6.024.1 | Dietician Services |
| 6.024.2 | Dietician Evaluation |
| 6.025.1 | Occupational Therapy Services |
| 6.025.2 | Occupational Therapy Evaluation |
| 6.026.1 | Speech Therapy Services |
| 6.026.2 | Speech Therapy Evaluation |
| SAFETY/INFECTION CONTROL | |
| 7.001.1 | Infection/Exposure Control Plan |
| 7.001.2 | CLIA Waiver |
| 7.002.1 | Universal Body Substance Precautions |
| 7.003.1 | Management of Infections/Exposures |
| 7.004.1 | Personal Protective Equipment |
| 7.005.1 | Hand washing |
| 7.006.1 | Aseptic Technique |
| 7.007.1 | Sterile Technique |
| 7.009.1 | Respiratory & Tuberculosis Precautions |
| 7.010.1 | Tuberculosis Exposure Control Plan |
| 7.011.1 | Contaminated Reusable Materials Disposition |
| 7.012.1 | Contaminated Waste Disposal |
| 7.013.1 | Therapy Bag Techniques |
| 7.015.1 | Communication of Hazards to Personnel |
| 7.016.1 | Hepatitis B Vaccination |
| 7.017.1 | Information & Training |
| 7.018.1 | Evaluating & Maintaining Records of infections |
| 7.019.1 | Reporting of Communicable Diseases |
| 7.020.1 | Record Keeping |
| 7.021.1 | Medical Equipment Malfunction |
| 7.022.1 | Hazardous Waste Handling & Labeling |
| 7.023.1 | OSHA Bloodborne Pathogen Training |
| 7.024.1 | Sentinel Event/Incident/Accident Reporting |
| 7.025.1 | Agency Personnel Safety/ Personal Safety |
| 7.026.1 | Agency Personnel Safety/ Unsafe Home Visits |
| 7.027.1 | Accidental Exposure |
| 7.028.1 | Accidental Prevention |
| 7.028.2 | Fall Prevention |
| 7.029.1 | Car Accident Reporting |
| 7.031.1 | Emergency Preparedness |
| 7.032.1 | Material Safety Data Sheet |
| 7.033.1 | Fire Safety |
| QUALITY MANAGEMENT | |
| 8.001.1 | Quality Assessment/Performance Plan |
| 8.002.1 | Patient Satisfaction Survey |
| 8.003.1 | Non Patient Satisfaction Survey |
| 8.004.1 | Data Quality Audits |
| PROVISIONS OF INTRAVENOUS THERAPY | |
| 9.001.1 | Provisions of Intravenous Therapy |
| 9.002.1 | Administration of IV Therapy |
| 9.003.1 | Nurse Responsibility |
| 9.004.1 | Patient Education |
| 9.005.1 | Anaphylaxis Protocol |
| 9.006.1 | Possession of Supplies |
| 9.007.1 | Possession of Saline, Certain Vaccines & Dangerous Drugs |
Our documents are State Specific, customized with your company information, and cross walked to the accreditation body of your choice as well as to state regulations. They are provided on hard copy with USB Drive or USB Drive only Version.
We have helped hundreds of agencies with their document needs from Hawaii to Alaska and Coast to Coast. We offer the best prices in the industry with the fastest delivery; our documents ship within 5 business days of your order.
Give us a call and let us know about your needs.
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