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Pandemic Agency Documentation

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COVID-19 (Coronavirus Agency relief effort)

The following templates, must be used for the Agency Pandemic Management Plan documentation


Vaccination full package: Covid-19 Vaccination Package              ACHC Approval


Agency Pandemic Management Plan:       CMS Guidelines Coronavirus               Vaccination Policy

Pandemic Mgm Plan                                    Coronavirus CMS guidelines                Vaccination Policy


Vaccine Info:  Vaccine English info            Vaccine Spanish info               Total staff vaccination report 


Staff Vac. Attestation:  Vaccine attestation          Staff vaccination log control: Vaccine log control


Vaccine Medical Exeption: Vaccine Medical Exp.    Religious Exeption: Vaccine Religious Exep.


Emerging Infections Disease Policy: EID Policy       Covid-19 Policy: Covid-19 Policy


Contingency Plan for ALF, Nursing Home staff testing:  Contingency Plan


Letter to staff on restricted areas: Letter to Staff        Bio Waste Disposal:  Disposal        


Goverment COVID-19 resources Covid-19         ACHC COVID-19 resources Covid-19

           CHAP COVID-19 resources Covid-19        JCHO COVID-19 resources Covid-19


 Emerging Infectious Disease (EID) report                            

EID Report   (forward copy to Board of Director & Infection Prev. Committee - monthly)            


Assessing Covid-19 Risks in the Workplace (monthly): Staff Risk Report 


Preventing Nosocomial COVID‐19 Infections: Preventing Nosocomial Infections   (monthly)


Pandemic Management Plan Compliance Report (Ibfection prevention) Pandemic Infec. Prev. Report    Monthly


Pandemic Log Control:  Patients           Staff


Caring for COVID-19 Patient documentation  Caring for Covid19 documentation  (Add to progress note)


Staff Weekly Screening Protocol:  WeeKly Screening     (must be completed daily to all Agency visitors)


Pandemic screening tool (patients):   Pandemic Screening   (must be complete weekly for patient/staff)


Caring for COVID-19 Patient guide (CHAP)  Caring for Covid19


Pandemic Agency Actions                                          Pandemic Response Roles

Pandemic Actions                                                       Pandemic Roles

Pandemic Infection Prevention                               Pandemic Home Care Planning

Pandemic Infection Prev.                                           Pandemic Agency HC planning report  


Covid-19 QAPI Report (Quarterly):  COVID-19 PI Report


Person Under Investigation (PUI) and Case Report Form:  Coronavirus PUI                             


COVID-19 Resources        National Emergency Waivers:  Waivers         CHAP Video waivers    FL Waivers

We encouraging organizations (CHAP and non-CHAP accredited) to participate in CHAP weekly COVID-19 conference calls. They have those calls on Tuesdays at 10:30 AM EST, Wednesday at 11:00 AM EST, and Thursday at 3:00 PM EST.  The call in number is 646-307-1479, participant code 246854#.  In addition, CHAP have a COVID-19 hotline for immediate questions 202-862-3416 (Monday-Friday 8:30 AM-5:30 PM EST).

CHAP Video: COVID19 tips              Patient/family Instructions: COVID19 English        COVID19 Spanish


JCHO Surveys Video: COVID19       CDC Infection prevention recommendation  CDC video


ACHC Instructions  COVID19           General Instructions Posters:  Poster English        Poster Spanish


Covid-19 Pamplet for your Staff and Patients Covid-19 Pamplet  $ 1.25 each, minimal order 25





Disclaimer: Every template is only your guide to complete Pandemic Management Documentation, your Agency Officials must assure that task were completed, the quorum is acceptable, and every member had active participation in the discussion, activities.