Members of the National Association for Home Care have asked us to establish an area on our web-site for sharing the policies/forms/protocols sent via e-mail to our Listserv. Permission has been given by member agencies to post the following documents

Administration/Risk Management

Agency Annual Review
Agency-Annual-Review.doc
Annual Evaluation
Annual-Eval.doc
Compliance Plan
Compliance-plan.doc
Computer Usage Policy
Computer-Usage-Policy.doc
Consent Infuenza/Pneumococcal Form
Consent-Flu-Pneu.doc
Consent Influenza/Pneumococcal Immunization Form
Consent-Flu-pneum.doc
Consent Influenza Vaccine Form
Consent-Flu-Vac.doc
Consent Influenza Vaccination Assessment Form
Consent-Flu.doc
Consent Information Influenza Vaccination Form
Consent-Info-FLU.doc
Discharge Policy
Discharge-Policy.doc
E-Signature Policy
E-Signature-Policy.doc
Liability of Equipment
Liability-of-equipment.doc
P & P Clinical Records
P&P-Clinical-Records.doc
P & P Insurance Verification
P&P-Insurance-Verification.doc
P & P Medicare Secondary Payor
P&P-Medicare-Second-Payor.doc
Physician Satisfaction Survey
Physician-Satisfaction.doc
Sentinel Event P & P
Sentinel-Event-P&P.doc
Sentinel Event P & P
Sentinel-Event-PP.doc
Sentinel Event Review Sentinel-Event-Review.doc

Adverse Event Audit Tools

Adverse Event Audit and Annual/Quarterly Quality Review
2001Audit.doc
Adverse Event ADL's
AE-ADLs.doc
Adverse Event Development of Urinary Tract Infection
AE-UTI.doc
Adverse Event Discharged to Community with Behavior Problems
AE-DC-behav.doc
Adverse Event Discharged to Community Needing Toileting Assistance
AE-DC-toilet.doc
Adverse Event Discharged to Community Needing Wound Care or Medication Assistance
AE-DC-wound-med.doc
Adverse Event Decline in Management of Oral Medications
AE-Decline-Oral-Med.doc
Adverse Event Emergent Care for Hypo/Hyperglycemia
AE-HypoHyperglycemia.doc
Adverse Event Emergent Care for Improper Medication Administration, Medication Side Effects
AE-Meds.doc
Adverse Event Emergent Care for Injury Caused by Fall or Accident in Home
AE-FALLS.doc
Adverse Event Emergent Care for Wound Infections, Deteriorating Wound Status
AE-WOUNDS.doc
Adverse Event Increase in Number of Pressure Ulcers
AE-Increase-Press-Ulcer.doc
Adverse Event Unexpected Death
AE-DEATH.doc
Adverse Event Unexpected Death
AE-Unexpected-Death.doc
Adverse Event Unexpected Nursing Home Admission AE-Nurs-Home.doc

Clinical

Child/Adolesent Assesment/Intervention Plan
Child-Assesment-Plan.doc
Infant/Child Assesment/Intervention Plan
Infant-Assesment-Plan.doc
Medication Administration
Medication-Admin.doc
Medical Social Work Assessment
MSW-Assessment.doc
Medical Social Services Clinical Note
MSW-Clinical-Note.doc
Medical Social Work Progress Note
MSW-Progress-Note.doc
Nutritional Assesment 1
Nutritional-Assesment-1.doc
Nutritional Assesment 2
Nutritional-Assesment-2.doc
Nutritional Assesment 3
Nutritional-Assesment-3.doc
OASIS Documentation Correction
OASIS-Correction- Form.doc
OASIS Documentation Correction
OASIS-Correction- Form.xls
OASIS Rehab Integrated Form
OASIS-SOC-Rehab.doc
Pain Assesment Tool
Pain-Assesment-Tool.doc
Protocol Fall Prevention
Protocol-Fall-Prevention.doc
Risk Assesment Falls
Risk-Assesment-Falls.doc
Social Work Assesment
Social-Work-Assesment.doc
Suicide Risk Assesment Tool & Contract
Suicide-Risk-Asst-Tool.doc
Wound Care Flow Sheet
Wound-care-flow-sheet.doc
Wound Care - Cleansing / Skin Protectant
Wound-clean.doc
Wound Care - Enzymatic Debriding Ointment
Wound-Enzymatic.doc
Wound Care - Hydrocolloid
Wound-Hydrocolloid.doc
Wound Care - Hydrogel
Wound-Hydrogel.doc
Wound Care - Lyofoam
Wound-Lyofoam.doc
Wound Care - PolyMem
Wound-Polymem.doc
Wound Care - Wet to Dry Wound-Wettodry.doc

Contracts

Speech Therapy Agreement STContract.doc

Disaster Plans

Biological and Chemical Weapons Plan
Bio-Chemical-Weapons.doc
Disaster Drill
Disaster-Drill.doc
Disaster Tracking Sheet
Disaster-Tracking-Sheet.doc
Disaster Worksheet
Disaster-Worksheet.doc
Emergency Evaluation
Emergency-Eval.doc
Emergency Preparedness P & P Emergency-Preparedness-P&P.doc

Educational Presentations

Care Plan Oversight (PowerPoint Presentation.ppt)
CPO-Cert-Recert-Pres.ppt
Care Plan Oversight (Modified Version in an MS Word document)
CPO-Cert-Recert-Pres.doc
Emergency Preparedness - BioTerrorism Presentation (PowerPoint Presentation.ppt)
BioTerrorism-Pres.ppt
Emergency Preparedness - BioTerrorism Presentation (Modified Version in an MS Word document) BioTerrorism-Pres.doc

Hospice

Hospice Chart Audit
Hospice-Chart-Audit.doc
Hospice Medication Policy
Hospice-Medication-Policy.doc
Hospice Orientation Outline
Hospice-Orientation-Outline.doc
Hospice Standing Orders Hospice-Standing-Orders.doc

Infection Control

Antibiotic Resistant Orgranisms
Antibiotic-Resistant-Orgran.doc
Disaster Drill 2004
DisasterDrill2004.doc
Employee Infectious Disease Log
Emp-Infectious-Disease-Log.doc
Home Care Bag
Home-Care-Bag.doc
Infection Control Report
Infection-Control-Report.doc
Infection Control Report Form
Infection-Cntrl-Report-Form.doc
Methicillin Resistant Staphylococcus Aureus (MRSA): Care of a Patient Colonized or Infected Form
MRSA.doc
Patient Infection Log
Patient-Infection-Log.doc
Resistant Organism Policy Resistant-Organism-Policy.doc

Miscellaneous

Insurance Authorization Worksheet
Insurance-Authorization.doc
Insurance Fact Sheet
Insurance-Fact-Sheet.doc
Medical Supply RFP
Medical-Supply-RFP.doc
Mileage Premium for High Priced Gas (Excel Document .xls) Mileage-Premium-High-Gas.xls

Other Audit Tools

CHF Rehospitalization Tool
CHF-Rehospitalization-Tool.doc
Comprehensive Review
Comprehensive-Review.doc
Home Care Chart Audit Chart-Audit-2.doc
Home Care End of Month Chart Audit Chart-Audit.doc

Personnel

Administrative Secretary
Administrative-Secretary.doc
Clinical Coordinator
Clinical-Coordinator.doc
Employee Satisfaction Survey
Emp-Satisfaction-Survey.doc
Enterostomal Therapy Clinical Nurse Specialist
ETCNS.doc
Employee Exit Interview Form - Employee
Exit-Interview-Employee.doc
Employee Exit Interview Form - Employer
Exit-Interview-Employer.doc
Financial Analyst
Financial-Analyst.doc
Home Care Aide
Home-Care-Aide.doc
Intake Coordinator
Intake-Job-description.doc
Licensed Practical Nurse
LPN -Job-description.doc
Orientation of Clinician to Home Care
RN-Orientation-Pathway.doc
Policy Case Management
Policy-Case-Management.doc
Social Worker Performance Evaluation
Social-Work-Perform-Eval.doc
Support Manager
Support-Manager.doc
Wound/Ostomy/Contience Nurse WOC-Nurse-Job-Desc-12-02.doc

Return to the HOMECARE Online Center!

We love receiving comments and suggestions for improvement!
Send them to webmaster@nahc.org