Professional Advisory Committee (PAC)

Emergency Plan

Same month every year (annually)

Complete the Data Sheet.

Complete the Agreement with another Agency. (Fax to us the information to complete/submit the Plan)

Your License must be renewed every 2 years

Renew License Form: 60 days before to expiration date.    CLIA application form

Training In Our Office

Every semester we offer 1 or 2 in-office training to your employees.

Bi-Annual Minutes of PAC meetings (Voluntary, no longer mandatory after 01/13/2018)

(First days of January and July each year)

Must participate:    DON

                                Administrator

                                RN, PT, OT, ST, MSW, HHA (including staffing company employee)

                                Community member (annually sign Conflict of interest Statement)

                                Physician (Voluntary Member of PAC, sign Business Associate Contract)

The following templates, must be used as Agenda for your meeting, the DON must assure that the meeting was done with acceptable quorum, and active participation of each member of the committee.

Discussion documents needed for PAC minute: (please distribute information to all Members)

Documents for PAC Meeting

Regular Minute (Agenda) (twice a year):

PAC Meeting Minutes

The following meetings must be done as needed:

Plan of Correction, after any survey minute:

Approval of Plan of Correction

PAC member Orientation                                       PAC member Confidentiality Statement:

                                     (at time of become member)

PAC Member Orientation                PAC Member Confidentiality

PAC Member Conflict of Interest (MD and Community member)

PAC Conflict of Interest (MD-Com)

Disclaimer: Every template is only your guide/AGENDA to type the Minutes of your meeting, your Agency Officials must assure that the meeting occur, the quorum is acceptable, and every member had active participation in the discussion