State Licensed Home Health
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Agency Start-up Pack
Tested , Compliance & Guaranteed
Quality systems that agencies all over the country have used for State Licensing and to run their agency.
Why you should evaluate our systems?
You can view everything immediately for review, with no cost or risk. You can start preparing for your state home health agency license instantly and everything is guaranteed.
What's Included
10 comprehensive packages (click on the contents below) to get through State LicensingĀ surveys & to run your agency efficiently.
*All products come with a Free Evaluation - Just click on the Free Evaluation button for the product that you want to view.
TOTAL OF 130 POLICIES & PROCEDURES
(*customized version slightly different per state)
31 Agency Operations Policies, 35 Human Resources Policies, 41 Clinical Policies, 23 Quality Management & Improvement Policies
Our Policy & Procedures will ensure that your Agency will use an established system that has successfully been used by many people to start and manage their businesses.
Well written Policies and ProceduresĀ enhances communication between all areas of your business. This will provide you with a more efficient agency and to stay in compliance with State laws.Ā
Easily identifiable Policies will help your employees to be more productive and at the same time to decide a course of action faster, whilst adhering to all legal guidelines.
AGENCY OPERATIONS
Approval of Policy & Procedures Manual
Policy & Procedure Manual Explained
Agency Mission Statement
Agency Objectives
Lines of Authority & Organizational Structure
Administrative Responsibilities
Home Health Care Philosophy
Purpose & Scope
On-Call Course of Action
Backup Services & After Hours Care
Agency Operating Hours
Methods of Communication
Communication Barriers & Providing Assistance
Physician Delegation
Processing Referrals
Service Area
Admission Qualifications
Non-Coverage of Service
Compliance & Implementation
Patient Conduct, Responsibilities, & Rights
Rights of the Elder
Advanced Directives
Fraudulent & Abusive Acts
Illegal Solicitation & Remuneration
Nondiscrimination
Financial Plan & Management
Financial Stability
Payment Change Notification
Billing
Agency Closure Process
Communicating LEP TDD
HUMAN RESOURCES
Employee File
Background Check
Verification Of Licensed Professionals
Drug Testing
Sexual Harassment
Verification of Vehicle Insurance & Driver's License
Mileage Reimbursement
Employee Initial TB Testing + Form
Employee Annual TB Test + Form
Dress Code
Cell Phone Usage
90 Day Probationary Period
Paid Holidays and Paid Leave
Employee Benefits
Definition of an Employee Visit
Classification of Personnel Positions
The Administrator
The Director of Nursing
Rules of Vocational Nurse Examiners
Home Health Aide Training / Evaluation / Supervision
Contract Services
Employee Evaluation
Employee Attendance & Leave
Employee Development Program
Orientation & Training
Management Training & Continuous Education
Confidentiality of Information
Employee Conduct
Disciplinary Actions
Violence in the Work Place
Grievance Procedure
Family / Medical Leave
Compliance of Agency Policies
Appropriate Clinical Training
Non-Compete Policy
CLINICAL
Admission Course of Action
Agency Safety Proctices
Therapy Admission Process
Supervising RN
Supervision of Clinical Staff
Physician Communication / Receiving Orders
Medical Record Protection
Confidentiality of Patient Information
Release of Patient's Medical Records
Patient Plan of Care
Correcting Errors of Agency & Patient Information
Use of Abbreviations for Agency & Patient Information
Therapy Services
Medical Social Worker Services
Delegation of Specific Nursing Tasks
LVN Assignment
Coordination of Care
Nutritional Counseling
Chart Order of Patient Information
Abuse / Neglect / Exploitation: Investigations & Reporting
Emergencies & Natural Disasters Plan + Form
Disaster & Priority Categorization + Form
Emergency Entry
Emergency Situation Plan
Medication Administration
Medication Worksheet & Schedule + Form
Medication Quality Management
Drug Manufacture Recall
Possession of Dangerous Drugs & Vaccines
Intravenous Therapy
Medical Records & Documentation
Client List & Services
Out of Hospital DNR + Form
Anaphylactic Reaction
CPR Administration
Caring for the Dying
Pronouncement of Death
Patient Discharge + Form
Patient Transfers + Form
Use of Restraints
QUALITY MANAGEMENT & IMPROVEMENT
Annual Agency Evaluation
Professional Advisory Committee
The Governing Board
Policy & Procedures Modifications + Form
Nurse Peer Review
Agency Supplies & Equipment
Management of Expired Supplies
CLIA : Clinical Laboratory Improvement Act
Laboratory Deliveries & Collection
Sharps & Medical Waste Management
Nurse Aide & Employee Misconduct Registry Check
HIPAA: Health Insurance Portability & Accountability Act
Quality Assessment & Performance Improvement
Patient Satisfaction Survey + Questionnaire Form
Patient Complaints + Form
Quarterly Clinical Review
Accident / Incident Reporting & Management + Report Form
Infection Control Management & Assessment + Assessment Form
Blood & Body Fluid Spills Handling
Reporting Communicable Diseases
Blood & Infectious Materials Exposure
Medical Device Reporting
Latex Sensitivity
Ā
Total of 95 Forms
40 General Agency Forms, 10 Meds & Labs Forms, 7 Discharge Forms, 15 Nursing Forms, 2 LVN/LPN Forms, 11 Therapy Forms, 6 Home Health Aide, 4 Medical Social Worker Forms
Don't waste your time on creating home health forms ā we've already done it for you.
Put your Agency Solutions in place faster by using our forms!
Over many years, our experienced team have developed efficient forms.
Our clinical forms will provide an effective solution with professional organization.
Our forms will deal with all administration needs throughout your agency and as our forms are provided in "Word" format, they can easily be altered to meet your requirements.
GENERAL AGENCY FORMS
Non-Coverage Letter
Patient Transfer Form
Post Hospital Assessment
Patient Post Hospital Check-List
Hospital Intake Form / Assessment
High Risk Screening Form
Employee In-Service Log
In-Service Sign In Sheet
Daily Agency Census
Wound Care Evaluation Sheet
Wound Care Flow Sheet
Release of Medical Information
Medical Supply/Equipment Sign Out Form
Medical Record Sign Out Log
Patient Weekly Diet Log
Notification Form
Interdisciplinary Progress Note
Accident Risk Assessment
Accident Risk Reduction
Active Patient List
ADR Request
Patient Consent Form
Daily Home Checklist
Directions to Patient Home
Disaster Assessment/ Care Coordination
Emergency Plan
Fax Transmittal Cover Sheet
New Order Communication Log
Nine Week Planner
Document Tracking Log Sheet
Patient Calendar Worksheet
Notification & Service Cooridination
Patient Progress Report
Physician Order Form
Post Fall Evaluation
Patient Visit Calendar Log
Referral Intake Form
Vitals Report to Physician
Vitals Log
MEDS & LABS FORMS
Medication Profile
Laboratory Questionnaire Form
Lab Flow Sheet
Glucometer Testing Weekly Record
Diabetic Log Form
Medication Instruction Sheet
Medication profile
Controlled Medication Verification Sheet
Daily Medication Calendar
Lab / Foley Log Form
NURSING FORMS
Nursing Visit Record
Nurse's Notes
Nurse's Missed Visit Report
Skilled Nursing Assessment Form
Teaching Checklist
RN Teaching Note
Skilled Nursing Mental Health Assessment
Supervision of Skilled Nursing
Supervisory Visit
Physician Update 60 Day Summary
Communication Note
Communication Note / Addendum
Supply Requisition Form
Nursing Services Flow-Sheet
LVN'S / LPN'S
LVN'S / LPN'S Patient Care Instructions
LVN'S / LPN'S Emergency Care Plan
THERAPY FORMS
Therapy Visit Note
Therapy Referral Form
Therapy Missed Visit Report
Monthly Supervisory Visit
Physical Therapy Evaluation Form
Occupational Therapy Evaluation Form
Speech / Language Evaluation Form
Discharge Summary Therapy
Therapy Skills Checklist
Patients Visit Calendar
Occupational Therapy Assessment
HOME HEALTH AIDE FORMS
Assignment Sheet
Skills Demo
Home Health Aid Evaluation
HHA Plan of Care
HHA Visit Note
HHA Supervisory Visit
DISCHARGE FORMS
Discharged Patient Agency List
Discharge Check-List
Discharge Order Form
Discharge Notice
Discharge Patient Log
Agency Release Form for Discharge
MEDICAL SOCIAL WORKER FORMS
MSW Skilled Visit
MSW Initial Visit / Plan of Care
MSW Initial Evaluation
MSW Referral / Order Form
Ā
30 Paged Booklet & A Total of 12 Forms
One of the first impressions your patient will have will be your Agency Admission Package. Why not get it right first time.
Our Patient Admission Pack is user friendly for staff and clients.
It looks professional and ensures compliance, whilst giving patients confidence and your business and efficient system.
FORMS
Referral Intake Forms
Interdisciplinary Flow Sheet
Planning Calendar
Disaster Preparedness Form
Coordination of Care
Directions to Patients Home
Change Agency Form
Emergency Plan
Consent Form
Medication Profile
Plan of Care
Satisfaction Questionnaire
30 Paged Booklet
Welcome to Home Health
Our Mission & Philosophy
Admission Eligibility
Services Provided by this Agency
Giving Consent to Treat You
Your Plan for Care
Agency Operating Hours
After Hours Coverage
Patient Satisfaction
Emergency Preparedness
Adverse Weather Conditions
Safety Basics at Home
Home Infection Control
Presenting a Grievance
How to File a Complaint
Drug Testing
Our Referral & Discharge Process
Security in your decision for Home Health
Security & Privacy Rights
Confidentiality & Access to your Records
Patient Rights
Patient Responsibilities
Rights of the Elderly
Advance Directives
Understanding Your Choices
Payment for Services / Charges
Ā
HUMAN RESOURCES PACK
Total of 36 Human Resources Forms
Human Resources forms and systems help you stay on track and keep employee records. Our professional team have devised efficient forms over many years.
These forms are designed to help an agency meet compliance and run the business smoothly. Our HR forms will help to organize your admin requirements. As these forms are in "Word" format they can be made to fit your individual needs.
WHATS INCLUDED
Request for Leave
Employee File Log Out Sheet
Team Meeting Sign-in Sheet
Personnel Status & Wage Change
Expense Form
Daily Personnel Activity Log
Employee Annual TB Testing
Interviewing Questions & Response : Clerical Staff
Interviewing Questions & Response : Clinical Staff
Interviewing Questionnaire for Nurses & LVN's/LPN's
Home Health Interviewing Questions
Interview Structure Report
Initial Employee Orientation
Nursing Skills Competency Tool
Therapy Skills Competency Tool
Intravenous Therapy Evaluation Tool
Intravenous Competency Log Sheet
Criminal History Acknowledgment
Criminal History Result Form
Emergency Employment Hire Form
Independent Contractor Agreement
Therapy Daily Activity Time Sheet
Employee Leave Request Form
Extra Hours Worked
Personnel Record Change
Payroll Notification
Shift Tracking Sheet
Employee Counseling
Comp Time Request
Active Employee Roster
Employee Processing Checklist
Ā
HIRING NEW PERSONNEL
New personnel are the key to the success of your Agency.
It is important that your employees comply with all Regulations, Policies and Procedures.
This enrollment package provides the forms and systems that will make hiring new staff a smoother and easier process for you.
WHATS INCLUDED
Home Health Care Specific Employment Application
Employment Agreement
Criminal History Consent Check
Wage / Mileage Agreement
Reference Check Form
Processing the New Employee
Employee Orientation
Cellular Phone Use
Dress Code
Drug Testing
Sexual Harassment
Universal Precautions Training Document
Confidentiality of Information Agreement
Reporting Abuse / Neglect / Exploitation
Orientation Acknowledgement
Agreement to Safety & Health
Agency Disclaimer of Liability
Following Infection Control Procedures
HBV Vaccine / Waiver Form
Non-Compete Agreement
Employee Initial TB Testing
Verification of Professional License
Ā
JOB DESCRIPTIONS PACKAGE
All agency employees are required to have a signed job description in their Human Resources file.
Defined job roles help to clarify individual employeeās duties and maintain compliance with state legislation.
This package will cover all the various types of staffing requirements within the home health industry.
WHATS INCLUDED
Administrator
Alternate Administrator
Alternate Director of Nursing
Billing Clerk
CEO Chief Executive Officer
CFO Chief Financial Officer
Director of Nursing
General Office Clerk
Home Health Aide
Human Resources
Physical Therapist
Physical Therapist Assistant
Psychoactive Services Registered Nurse
Receptionist
Registered Nurse
Speech Therapist
Speech Therapy Assistant
LVN / LPN
Medical Records Clerk
Medical Social Worker
Occupational Therapist Assistant
Occupational Therapist
Payroll Manager
Ā
QUALITY MANAGEMENT & PERFORMANCE IMPROVEMENT
It is vital to have Quality Assurance and Performance Improvement tracking documents in Home Healthcare.
We supply the tools and solutions to give you the confidence that your agency will stay compliant in this highly regulated industry.
WHATS INCLUDED
Annual Agency Evaluation
90 Day Chart Review / Clinical Summary
Home Health Care Quality Improvement
Quality Assurance Log
Case Conference Form
Case Conference / Physician Report
Case Conference Log Sheet
Complaint Assessment Form
Complaint Log Sheet
Infection Control Assessment Form
Infection Control Log Sheet
Incident Assessment Form
Incident Log Sheet
Accident Assessment Form
Accident Log Sheet
Clinical Contractor Evaluation Form
Performance Evaluation Form
QI Quarterly Review
Clinical Record Audit
Active Clinical Record Review
Discharge Record Review Form
Annual Clinical Record Review
Corrective Action Report
Satisfaction Survey Questionnaire
Satisfaction Survey Log
Request for Change of Policy Form
P.A.C Attendance
Q.I Quick Check
Ā
HIPAA ORIENTATION
Health Insurance Portability & Accountability Act
Agencies are required to have systems and policies in place to maintain patient information confidentiality and to secure the safety of medical records. This manual will guide you and your personnel.
15 Paged Manual
Ā HIPAA OrientationĀ And Guide
SAMPLE CONTRACTS
These sample contracts will be a useful resource when managing your agency.
Back Up Services Agreement (essential for license)
A contract with another Agency to provide Back Up Services in any event. An Agency shall have systems in place to ensure that back-up services are available to provide services to patients when the assigned employee or contractor is not able to deliver the services.
Non Compete Agreement
Ensures employees, contractors, suppliers adhere to this Agreement.
This Agreement shall include but not be limited to, procedure manuals, in-house policies, patient lists, patient's medical records, financial information and billing records, certifications and applications, actual and prospective markets and patients, business plans and marketing strategies, customer lists, sales and marketing data, operating statements, income statements, asset and liability information, financial projections and any other confidential information gathered, revealed, acquired or generated by or for the Agency.
Confidentiality Agreement
In order to protect any individual from invasion of privacy and to protect the interest of the Agency, any information gathered for patient care or operations will be gathered, maintained, and stored in such a manner as to assure confidentiality.
Ā
MEETINGS PACKAGE
SAMPLE DOCUMENTATION TEMPLATES
Meeting Minutes, Meeting Agendas & Committee Evaluation Tools
GOVERNING BOARD
The Governing Board Manages the Agency Operations reviews & approves the Agency Annual Budget, Annual Agency Evaluation, Policies & Procedures.
Sample Governing Board Meeting Minutes
Governing Board Self Evaluation Protocol 3pgs
(PAC) PROFESSIONAL ADVISORY COMMITTEE
The PAC Committee advises on professional issues and in the evaluation of the agency & it's programs it also helps to maintain liaisons between the local community.
Sample PAC Meeting Agendas
Sample PAC Meeting Minutes
Annual Agency Evaluation Pack 5pgs
BUDGET COMMITTEE
The Agency's Management Staff under the direction of the Governing Board prepares an overall plan & budget that includes an annual Operating Budget and a Capital Expenditure Plan.
Sample Budget Committee Meeting Minutes
(QAPI) QUALITY ASSESSMENT PERFORMANCE IMPROVEMENT COMMITTEE
The QAPI Committee will address areas for improvement that are cost effective and also perform periodic assessments of care and service.
Sample QAPI Committee Meeting Minutes
Ā
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Products Sold Individually
*All products come with a Free Evaluation - Just click on the Get Templates button for the product that you want to download.
TOTAL OF 131 POLICIES & PROCEDURES
(Templates only version)
30 Agency Operations Policies, 34 Human Resources Policies, 45 Clinical Policies, 22 Quality Management & Improvement Policies
Our Policy & Procedures will ensure that your Agency will use an established system that has successfully been used by many people to start and manage their businesses.
Well written Policies and ProceduresĀ enhances communication between all areas of your business. This will provide you with a more efficient agency and to stay in compliance with State laws.Ā
Easily identifiable Policies will help your employees to be more productive and at the same time to decide a course of action faster, whilst adhering to all legal guidelines.
AGENCY OPERATIONS
Approval of Policy & Procedures Manual
Policy & Procedure Manual Explained
Agency Mission Statement
Agency Objectives
Lines of Authority & Organizational Structure
Administrative Responsibilities
Home Health Care Philosophy
Purpose & Scope
On-Call Course of Action
Backup Services & After Hours Care
Agency Operating Hours
Methods of Communication
Communication Barriers & Providing Assistance
Physician Delegation
Processing Referrals
Service Area
Admission Qualifications
Non-Coverage of Service
Compliance & Implementation
Patient Conduct, Responsibilities, & Rights
Rights of the Elder
Advanced Directives
Fraudulent & Abusive Acts
Illegal Solicitation & Remuneration
Nondiscrimination
Financial Plan & Management
Financial Stability
Payment Change Notification
Billing
Agency Closure Process
HUMAN RESOURCES
Employee File
Background Check
Verification Of Licensed Professionals
Drug Testing
Sexual Harassment
Verification of Vehicle Insurance & Drivers License
Mileage Reimbursement
Employee Initial TB Testing + Form
Employee Annual TB Test + Form
Dress Code
Cell Phone Usage
90 Day Probationary Period
Paid Holidays and Paid Leave
Employee Benefits
Definition of an Employee Visit
Classification of Personnel Positions
The Administrator
The Director of Nursing
Rules of Vocational Nurse Examiners
Home Health Aide Training / Evaluation / Supervision
Contract Services
Employee Evaluation
Employee Attendance & Leave
Employee Development Program
Orientation & Training
Management Training & Continuous Education
Confidentiality of Information
Employee Conduct
Disciplinary Actions
Violence in the Work Place
Grievance Procedure
Family / Medical Leave
Compliance of Agency Policies
Appropriate Clinical Training
CLINICAL
Admission Course of Action
Therapy Admission Process
Supervising RN
Supervision of Agency Services
Supervision of Clinical Staff
Physician Communication / Receiving Orders
Physician Stamped Signature
Medical Record Protection
Confidentiality of Patient Information
Agency / Client Agreement & Disclosure
Release of Patient's Medical Records
Patient Plan of Care
Correcting Errors of Agency & Patient Information
Use of Abbreviations for Agency & Patient Information
Therapy Services
Medical Social Worker Services
Delegation of Specific Nursing Tasks
LVN Assignment
Coordination of Care
Nutritional Counseling
Chart Order of Patient Information
Abuse / Neglect / Exploitation: Investigations & Reporting
Emergencies & Natural Disasters Plan + Form
Disaster & Priority Categorization + Form
Emergency Entry
Emergency Situation Plan
Medication Administration
Medication Worksheet & Schedule + Form
Medication Quality Management
Drug Manufacture Recall
Possession of Dangerous Drugs & Vaccines
Intravenous Therapy
Assistance with Medications by a Home Health Aide
Medical Records & Documentation
Client List & Services
Out of Hospital DNR + Form
Anaphylactic Reaction
CPR Administration
Caring for the Dying
Pronouncement of Death
Patient Discharge + Form
Patient Transfers + Form
Use of Restraints
Latex Reaction & Alternatives + Chart
QUALITY MANAGEMENT & IMPROVEMENT
Annual Agency Evaluation
Professional Advisory Committee
The Governing Board
Policy & Procedures Modifications + Form
Nurse Peer Review
Agency Supplies & Equipment
Management of Expired Supplies
CLIA : Clinical Laboratory Improvement Act
Laboratory Deliveries & Collection
Sharps & Medical Waste Management
Nurse Aide & Employee Misconduct Registry Check
HIPAA: Health Insurance Portability & Accountability Act
Quality Assessment & Performance Improvement
Patient Satisfaction Survey + Questionnaire Form
Patient Complaints + Form
Quarterly Clinical Review
Accident / Incident Reporting & Management + Report Form
Infection Control Management & Assessment + Assessment Form
Blood & Body Fluid Spills Handling
Reporting Communicable Diseases
Blood & Infectious Materials Exposure
Medical Device Reporting
PEDIATRIC ADD ON PACKAGE
The Pediatric Package will help your agency become compliant with legislation on Pediatric care. All the policies and forms you will need are included.
Documentation for adults is not suitable for children because the forms do not ask the necessary questions. Relevant questions may be about the motherās labor, or childhood disorders/illnesses, also whether developmental milestones were met?
The Pediatric Package will help your pediatric home health business be more efficient and better able to service your young patient and their parents.
ADD ON PEDIATRIC POLICIES & PROCEDURES
Pediatric Admission Process
Supervision of Pediatric Care
Pediatric Services
ADD ON PEDIATRIC JOB DESCRIPTIONS
Pediatric Nurse
Pediatric LVN / LPN
PEDIATRIC SPECIFIC FORMS
Pediatric Assessment
Pediatric Plan of Care
Pediatric Visit
Pediatric Supervisory Visit
Reviewing Pediatric Charts
Pediatric Weekly Communication Note
Therapy Pediatric Assessment
Skilled Nursing Pediatric Assessment
Pediatric Nursing Skills Checklist
Pediatric Speech Language Pathology Evaluation/Plan of Care
PEDIATRIC ADMISSION PACKAGE
Welcome to Pediatric Home Health
Understanding Pediatric Home Health
Pediatric Admission Consent Form
Back Up Services Policy
Changing Your Home Health Agency Form
Child Safety in the Home
Drug Testing Policy
Contacting Parents / Caregiver Form
Emergency / Disaster Plan
Child & Parent (Patient Responsibilities)
Mission Statement
Nondiscrimination Policy
Disposal of Sharps Safely
Protection of Patient Confidentiality
Safety Check-List
On Call Process
Patient Right's
Reporting Abuse & Neglect
Ā
" I would highly recommend the agency startup pack to any that value their time"
Surpassion Health Care Services, LLCĀ Owner/Administrator
"So hard choosing the right consultants. You saved us a lot of time."
Alexia Health Services, LLC
"An amazingly easy transition to the Mobile Workforce Solution."
Vista Home Care Services, LLC
"What a great set of tools. We have even been doing HHA in-service via video"
Jasmine Community Care, Inc.
"Did what you said and thanks for getting my state license application passed"
J.Lorega . R.N,Ā First Choice Group
"The surveyors commented how the policies and procedures were well written"
D.Eaden Administator, Ā Progress Care Options, LLC
"I tried to do it on my own. You came in & solved everything"
Owner - Bright Stars Home Health, LLC
"I would highly recommend your Policy and Procedures"
M.Hagerty Supervisor/Owner, Angels Care in Action
"Chose the right consultants. I could look at everything before spending money"
Joan Browne ā Owner, Belmont Home Health, LLC
"What a great service. Thanks for helping me start this agency"
M.Sailsbury ā Administrator,Ā Compassion Home Sevices
"I was a bit worried starting my agency but you helped me when I needed it"
At Home Health Care, LLC, Owner
"Great website and service. I never would have done this without you"
Living Tree Personal Care