Emergency Plan
Same month every year (annually)
Complete the Agreement with another Agency. (Fax to us the information to complete/submit the Plan)
Same month every year (annually)
Complete the Agreement with another Agency. (Fax to us the information to complete/submit the Plan)
Renew License Form: 60 days before to expiration date. CLIA application form
Every semester we offer 1 or 2 in-office training to your employees.
(The templates must be updated with your discussion during
preparation of your PI and QA program, and Agency's data and
reality, your DON must review/approve the reports and data
collection.)
Also: Please complete to be ready for new CoPs:
1) The Clinical Record review minute and support documents
2) ALL monthly/quarterly report
3) ALL Logs
DON/QA Staff: Template for Performance Improvement Data Collection/Analyzes:
Performance Improvement Data PI Monitoring Log
DON: Performance Improvement Plan: Target for Improvement or Replication (quarterly)
Performance Improvement Plan PI target for improvement report
DON/QA staff: Progress Note review form Sign Up Package check up form
Progress Notes Review Form Sign Up Package Check list
DON/QA Staff: Chart Audit check list Q60 days (On Recert or Discharge)
QA Audit Form Private Duty: QA Audit Form (Private Duty)
DON/QA Staff: POC Tips
PANIC VALUE list: (Verify that if any parameter is out of normal limit, the patient's physician was notified)
PANIC VALUE (Can be customized, if changed please replace that page in your Policy Manual)
QA Staff: Verification of visits/services patients random calls (Monthly)
QA Staff: Performance Improvement Bar Graphic Study sample:
Administrator/DON: Survey Ready Check List
For use by PN System's QA Nurse only:
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
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