INTERNAL OPERATING FORMS
  • Mission, Vision & Values

  • Organizational Structure

  • Staffing & Staff Structure

  • Operating/Service Hours

  • Management Roles & Responsibilities

  • Job Descriptions

         - Administrator

         -  Alternate Admin

         -  Care Supervisor

         -  Visiting Nurse

         -  Financial Manager

         -  Homemaker

         -  Personal Attendant (HHA, CNA)

  • Emergency Preparedness Plan

  • Client Assessment

  • Admission Forms

  • Client Care Notes

  • Client Complaint Form

  • Client Complaint Registry Form 

  • Client Daily Activity Log

  • Client Emergency Calling List

  • Client Gift Form

  • Client Home Safety Checklist

  • Client Manual Time Log

  • Client Medication Log

  • Client Medications Record From

  • Client Satisfactory Survey From

  • Client Services Agreement

  • Client Task Log 

  • Incident Report Form

  • Notice of Privacy Practices

  • Pricing for Services Form

  • Release of Medical Information Form

PROVIDER ENROLLMENT

Checklist for Sole Proprietor or Solely Owned Organizations (eg. LLC, PC)Below is a checklist of information that will be needed to complete enrollments via Internet-based PECOS:

An active National Provider Identifier (NPI).

-Sole Proprietors only need a type 1  NPI

-Solely Owned Organizations need both a type 1 NPI & type 2 NPI

National Plan and Provider Enumeration System (NPPES) User ID and password. Internet-based PECOS can be accessed with the same User ID and password that a physician or non-physician practitioner uses for NPPES.

 

For help in establishing an NPPES User ID and password or assistance in changing an NPPES password, contact the NPI Enumerator at 1-800-465-3203 or send an e-mail to

customerservice@npienumerator.com.

Personal identifying information. This includes:

  • Legal name on file with the Social Security Administration

  • Date of birth

  • Social Security Number

Schooling information. This includes:

  • Name of School

  • Graduation year

See our Enrollment Page for more information

HOME CARE POLICIES AND PROCEDURE MANUALS
  • Administrative Policy and Procedures

  • Annual Quality Improvement Policy

  • Business Continuity Policy

  • Caring for Culturally Diverse Clients Policy

  • Client Admission and Discharge Policy

  • Client Billing Policy and Procedures

  • Client Complaint Policy

  • Client Complaint Policy - Administrative

  • Client Record System Policy and Procedures

  • Client Refunds Policy

  • Client Rights Policy

  • Client Termination and Referral Policy

  • Office of Inspector General Exclusion Policy

  • HIPAA Compliance Policy

  • Contract Services Policy

  • Correction and Prevention of Billing Errors Policy

  • COVID-19 Policy and Procedures

  • Employee Hiring Policy. Employment Practices  

  • Emergency Preparedness Plan:

     - Client Emergency Preparedness Plan

     - Family Emergency Preparedness Plan

     - Emergency Preparedness Plan

     - Staff Emergency Preparedness Plan

  • Employee Performance Review Policy

  • Exposure Control Plan Bloodborne Pathogens

  • Financial Control Policy

  • Infection Control Policy

  • Infection Prevention Guidelines

  • Maintaining a Drug-Free Workplace Policy

  • Memorandum of Understanding Policy

  • New Employee Orientate Policy

  • On-Call Procedures Policy

  • Orientation to Individual Care Assignments

  • Personnel Policy 

  • Records, Access, Storage, and Retention Policy

  • Abuse, Neglect, and Explorations Policy

  • Responsibilities and Work Assignments Policy

  • Scope of Services Policy

  • In-Service Training Policy

  • Staff Supervising Policy

  • Standard of Conduct Policy

  • Tuberculosis Exposure Control Policy

  • Work Attendance Policy

  • Comprehensive Emergency Management Plan

EMPLOYMENT RELATED FORMS and PROCEDURES
  • Applicant Interview Form

  • Auto Insurance From

  • Consent/Drug and Alcohol Screening Test

  • Criminal Disclosure Form

  • Direct Deposit Form

  • Disciplinary Action Report Form

  • Disclosure/Release/Authorization Form

  • Driver Safety Program

  • Employee Emergency Contact Form

  • Employee Orientation Handbook Manual

  • Employer and Employee Agreement

  • Employment Authorization Form

  • Federal and State Tax Forms

  • HIPAA Compliance Agreement

  • Home Care Employment Application

  • New Employee Acknowledgement Form

  • New Employee Orientation Form

  • Non-Compete Agreement

  • Performance Appraisal Form

  • Responsibilities and Work Assignments

  • Work Attendance Form