Home Care Policies

If you are in need of any of these policies and procedures, please send E-mail. Be sure to include the name and # of the policies that you desire. The first 5 policies are free. Additional policies will be made available for a fee. A CD of all of the policies will be available in the near future on our website. If you are interested in the CD, please contact us by E-mail so that we have an idea of the approximate number of CD’s needed for possible purchase.

2005 HC-POLICY JCAHO REF

POLICY NAME	SECTION & POLICY #	POLICY CROSS REFERENCE #		JCAHO STANDARD(S)
*RIGHTS & ETHICS*	*SECTION I*
*Patient Information Packet*	*1001*			*RI.2.60* *RI.2.20*
*Patient Rights & Responsibilities* *Procedural Aspects*	*1002*			*HR.2.10* *RI.2.70* *RI.2.10* *RI.2.30*
Home Care Patient Rights & Responsibilities	*1003*			*HR.2.10* *RI.2.30* *RI.2.10* *RI.2.70*
*HIPPA Regulations & Patient Information*	*1003 A*			*RI.2.20* *RI.2.30* *RI.2.10*
*HIPPA*	*1003 B*			*RI.2.30* *HR.2.10*
*Advance Directive Policy*	*1004*			*RI.2.20-ER.2-3* *RI.2.80-ER.1-9*
*Patient Information on Advance Directives*	*1004 A*			*RI.2.20* *RI.2.80*
*Durable Power of Attorney*	*1005*			*RI.2.70*
*Declaration*	*1006*			*RI.2.30*
*Patient Informed Decision Making*	*1007*	*1003*		*RI.2.30*
*Consents*	*1008*
*Patient Consents & Authorizations Form*	*1009*	*10007*
*Clinical Documentation*	*1010*	*10007*
*Destruction and Disposal of Protected Health Information Media*	*1010 A*
*Photographing or Videotaping of Clients*	*1011*			*RI.2.50*
Consent to Photograph/Video Form	*1011 A*	*10007*		*RI.2.50* *IM.6.20*
*Emergency Intervention*	*1012*
*Do Not Resuscitate/Do Not Intubate*	*1013*
*DNR/DNA Request Form*	*1014*	*10007*
*Withholding/Withdrawing Life Support*	*1015*			*RI.2.10* *RI.2.30* *RI.2.70*
*Patient Complaints*	*1016*			*RI.2.120*
*About the Right to Express Grievances*	*1017*			*RI.2.120*
*Patient Complaint Form*	*1018*			*RI.2.120*
*Confidentiality of Information*	*1019*	*10003*		*IM.2.10* *IM.6.10* *RI.2.130*
*Confidentiality Statement Form*	*1020*	*10003 A*		*IM.1.20*
*Sensory Impaired Patients*	*1021*			*RI.2.100*
*Non-English Speaking Patients-Cultural Considerations*	*1022*			*RI.2.100*
*Code of Ethics*	*1023*			*RI.1.10*
*Ethics Committee*	*1024*			*RI.1.10*
*Conflict Resolution*	*1025*			*RI.2.30*
*Acceptance of Patients*	*1026*
*Conflict of Interest*	*1027*			*RI.1.10* *RI.1.20*
*Conflict of Interest Disclosure Statement*	*1028*			*RI.1.20*
*Ethical Practices-New Life*	*1029*			*RI.1.10*
*Integrity Of Clinical Decision-Making*	*1030*			*RI.1.30* *RI.1.40*
*Protecting Patients from Abuse*	*1031*			*RI.2.150*
*Protective Services*	*1032*			*RI.2.170*

ASSESSMENT OF PATIENTS	SECTION II
*Intake Services*	*2001*			*PC.2.20*
*Admission Record Form*	*2002*	*10007*		*PC.2.20* *IM.6.10*
*Intake/Referral Form*	*2003*	*10007*		*PC.2.20* *IM.6.10*
*Orders for Service Form*	*2004*	*10007*		*IM.6.10*
*Patient Assessment Functions & Qualifications*	*2005*			*PC.2.20* *PC.2.120*
*Assessment*	*2006*				*PC.2.20* *PC.2.120* *PC.8.10*
*Nursing Assessment/Medical History Form*	*2007*	*10007*			*PC.2.20* *PC.2.120* *PC.8.10 (Pain)*
*Nursing Progress Report Form*	*2008*	*10007*			*IM.6.10* *PC.8.10 (Pain)*
*Nursing Diagnosis Form*	*2009*	*10007*			*IM.6.10*
*Proposed Plan of Treatment Form*	*2010*	*10007*			*PC.4.10*
*Patient Abuse*	*2011*				*PC.3.10*
*Patient Abuse-Child*	*2012*				*PC.3.10*
*Suspected Adult or Child Abuse Report Form*	*2013*	*10007*			*PC.3.10* *IM.6.10*
*Reassessment*	*2014*				*PC.2.150*

*CARE, TREATMENT & SERVICES*	*SECTION III*
*On-Call Coverage*	*3001*
*Care Planning*	*3002*				*PC.4.10*
*Patient Identifiers*	*3002 A*				*PC.5.10*
*Home Health Certification and Plan of Treatment Form*	*3003*	*10007*			*IM.6.10* *MM.1.10* *PC.2.150* *PC.4.10*
*Skilled Nursing Plan of Care Form*	*3004*		*10007*		*IM.6.10* *MM.1.10* *PC.4.10*
*Personal Care Instructions*	*3005*				*IM.6.10*
*Personal Care Instructions Form*	*3006*		*10007*		*IM.6.10*
*Confirmation of Physician Telephone/Verbal Orders Policy*	*3007*		*10007*		*IM.6.10*
*Confirmation of Physician Tel*