INTERNAL OPERATING FORMS
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Mission, Vision & Values
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Organizational Structure
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Staffing & Staff Structure
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Operating/Service Hours
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Management Roles & Responsibilities
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Job Descriptions
- Administrator
- Alternate Admin
- Care Supervisor
- Visiting Nurse
- Financial Manager
- Homemaker
- Personal Attendant (HHA, CNA)
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Emergency Preparedness Plan
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Client Assessment
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Admission Forms
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Client Care Notes
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Client Complaint Form
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Client Complaint Registry Form
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Client Daily Activity Log
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Client Emergency Calling List
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Client Gift Form
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Client Home Safety Checklist
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Client Manual Time Log
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Client Medication Log
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Client Medications Record From
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Client Satisfactory Survey From
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Client Services Agreement
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Client Task Log
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Incident Report Form
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Notice of Privacy Practices
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Pricing for Services Form
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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:
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Legal name on file with the Social Security Administration
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Date of birth
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Social Security Number
Schooling information. This includes:
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Name of School
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Graduation year
HOME CARE POLICIES AND PROCEDURE MANUALS
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Administrative Policy and Procedures
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Annual Quality Improvement Policy
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Business Continuity Policy
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Caring for Culturally Diverse Clients Policy
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Client Admission and Discharge Policy
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Client Billing Policy and Procedures
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Client Complaint Policy
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Client Complaint Policy - Administrative
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Client Record System Policy and Procedures
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Client Refunds Policy
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Client Rights Policy
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Client Termination and Referral Policy
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Office of Inspector General Exclusion Policy
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HIPAA Compliance Policy
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Contract Services Policy
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Correction and Prevention of Billing Errors Policy
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COVID-19 Policy and Procedures
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Employee Hiring Policy. Employment Practices
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Emergency Preparedness Plan:
- Client Emergency Preparedness Plan
- Family Emergency Preparedness Plan
- Emergency Preparedness Plan
- Staff Emergency Preparedness Plan
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Employee Performance Review Policy
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Exposure Control Plan Bloodborne Pathogens
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Financial Control Policy
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Infection Control Policy
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Infection Prevention Guidelines
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Maintaining a Drug-Free Workplace Policy
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Memorandum of Understanding Policy
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New Employee Orientate Policy
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On-Call Procedures Policy
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Orientation to Individual Care Assignments
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Personnel Policy
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Records, Access, Storage, and Retention Policy
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Abuse, Neglect, and Explorations Policy
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Responsibilities and Work Assignments Policy
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Scope of Services Policy
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In-Service Training Policy
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Staff Supervising Policy
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Standard of Conduct Policy
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Tuberculosis Exposure Control Policy
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Work Attendance Policy
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Comprehensive Emergency Management Plan
EMPLOYMENT RELATED FORMS and PROCEDURES
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Applicant Interview Form
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Auto Insurance From
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Consent/Drug and Alcohol Screening Test
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Criminal Disclosure Form
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Direct Deposit Form
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Disciplinary Action Report Form
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Disclosure/Release/Authorization Form
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Driver Safety Program
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Employee Emergency Contact Form
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Employee Orientation Handbook Manual
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Employer and Employee Agreement
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Employment Authorization Form
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Federal and State Tax Forms
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HIPAA Compliance Agreement
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Home Care Employment Application
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New Employee Acknowledgement Form
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New Employee Orientation Form
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Non-Compete Agreement
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Performance Appraisal Form
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Responsibilities and Work Assignments
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Work Attendance Form