Staff Application Pack
(For all disciplines)

(Minimum order 5 / discipline)
Ready to use, updated as required, only $ 2.59 each

(For all disciplines)

(Minimum order 5 / discipline)
Ready to use, updated as required, only $ 2.59 each

Renew License Form: 60 days before to expiration date. CLIA application form
PRIVACY AND SECURITY NOTICE REGARDING ELECTRONIC
FORMS. Our electronic forms are provided solely as a convenience
to assist Home Health Agencies in completing required documentation. The
forms operate within your web browser and are intended for local use by
authorized agency personnel. No patient information entered into these forms
(if any) is collected, stored, saved, transmitted, processed, or retained by
our website, servers, or systems. The information entered remains under the
control of the user and is used only to generate or complete the form for
the agency's own records. Because no protected health information (PHI) is
received, maintained, saved, or retained by our website, we do not create or
maintain a database of patient information from these forms. This website is
protected by a valid HTTPS Secure Sockets Layer (SSL/TLS) certificate, which
encrypts communications between your web browser and our website to help
protect the integrity and security of your connection. Home Health Agencies
remain solely responsible for ensuring that any completed forms are handled,
stored, transmitted, printed, or incorporated into their medical,
administrative record systems in compliance with all applicable federal and
state laws, including the Health Insurance Portability and Accountability
Act (HIPAA), the Health Information Technology for Economic and Clinical
Health (HITECH) Act, applicable Centers for Medicare & Medicaid Services
(CMS) Conditions of Participation, and any other applicable state and
federal privacy and security requirements. By using these electronic forms,
users acknowledge that they are responsible for maintaining the privacy,
security, and confidentiality of any patient information after the form has
been completed. Please Note: While this website uses industry-standard HTTPS
(SSL/TLS) encryption to secure communications, HIPAA compliance ultimately
depends on how each Home Health Agency uses, stores, transmits, and
safeguards Protected Health Information (PHI) after the form has been
completed.

CALENDAR of In-services (Monthly, must be posted in the Agency's Board)
Attendance Record: Attendance Record
FULL YEAR TRAININGS: Materials for the training, Certificates:
If your Agency Use, authorize Artificial Intelligence (AI): AI Staff Training
JANUARY: Infection Control, Handwashing, Bag
Technique, TB Precautions, Exposure Plan, Bloodborne Pathogens,
Biomedical Waste Protocol,
(All field staff)
Play video
Infection/TB Control Training Biomedical
Waste training ![]()
Training Outline Attachment A Attachment B
Handwashing training Bloodborne Training
Bag technique, Patient Assessment, Handwashing procedures/staff training:
TIPS:
Prevent Exposure in Unsafe Conditions Prevent Latex Allergies
Tips for Reducing Exposure to Bloodborne Pathognes
Tips for Reducing Risks From Environmental Exposures
FEBRUARY: Cultural Background,
Belief, Grievance/Complaints,
Incident Reporting, Conflict of Interest, Advanced Directives,
Abuse Reporting, Handling Barrier to
Communicate.
Cultural Background, Complaints, Incident, Abuse, etc.
Correct Documentation training: Documentation Integrity Training
MARCH: Medical Device Act, Home Instrument Use and
Maintenance
Medical Device Home Instrument Use/Mtn Waived (CLIA) Training
APRIL: Fraud Prevention, Compliance Guidelines,
Reporting. Sexual Harassment Prevention, Workplace Violence
Prevention - Drug free workplace.
Fraud Prevention/Compliance Harassment Prevention training
Workplace Violence prevention training TIPS: Prevent Violence on the Job
MAY: Emergency In-Service, Hazard Vulnerability,
Disas
ter Drill, OSHA Compliance, OSHA Hazard Communication
(Right to Know)
Staff training attestation form Attestation (add to staff record)
JUNE: Ethical Issue, HIPAA Compliance
Ethical Issue HIPAA Guidelines
JULY: Safety Management Plan, Staff and Patient (Home
Care Environment), Office Staff Safety Training.
PLEASE select according your Accreditation body.
State (No Accreditation) CHAP
Safety Management Training Safety Management training (CHAP)
Joint Commission ACHC
Safety Management Training Safety Management Trainging (ACHC)
Office Staff Safety training
Office Staff Safety Training Oxygen Precautions Training
TIPS:
Prevent Driving-Related Injuries Prevent Musculoskeletal Disorders
Prevent Needlestick and Sharps Injuries
Safety With Clients With Dementia Tips Reducing Strains, Sprains, & Falls
AUGUST: Civil Rights Compliance, Bill of Rights, Home
Care Professional Boundaries, Non-Discrimination (Section 1557)
State (No Accreditation) CHAP
Civil, Bill or Rights training Civil, Bill of Rights training (ACHC)
Joint Commission ACHC
Civil, Bill of Rights training (JCHO) Civil, Bill of Rights training (ACHC)
Home Care Professional Boundaries Non-Discrimination (Section 1557)
Home Care Professional Boundaries Section 1557 training
SEPTEMBER: Service Agreement/Conveying Charges.
Influenza Vaccine training
Service Agreement/Conveying Charges Influenza training
ADMINISTRATOR Responsibilities: Influenza Vaccine Rate Compliance Goal LOG
(must be posted in the Agency's Board, monthly)
ADMINISTRATOR/HR: Staff Influenza Declination Analyzes, Report to BD (Quarterly): Influenza Declination Analyzes
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OCTOBER: Home Health Information Technologies, Disease
& Medication Specific Information
Information Technologies Disease & Medication Specific
If your Agency Use, authorize Artificial Intelligence (AI): AI Staff Training
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NOVEMBER:
Medication Management Program, Prevention Medical errors
Medication Management Prevention of Medical Errors
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DECEMBER: Pain Management, Fall Prevention
Pain Management training Fall Prevention Training
Patient guide to safe prescribed Opioids use
Extras Trainings as needed:
Professional Admission Staff Training:
S/U pack training S/U staff training2 S/U staff presentation
If needed: (Complete only if you have wound care, IV therapy cases, any virus, etc.)
Wound Care training IV Therapy In-Service
Ebola training Zika Virus In-Service
Covid-19 In-Service MonkeyPox In-Service
2018 New Conditions of Participation training: 2018 Medicare CoPs
Aide Special training as applicable: -----------------------------------------------------------
Aide, CNA Training, Care of Minor and Pediatric Patients Aide Minor Care
Minors, Pediatric Care Competency Validation form: Aide Competency
Aide staff Changes in Skin Condition training: Aide Skin changes training
Disclaimer: Every training material is only your Guide to complete each in-service, your DON/Education coordinator must review/approve the matetial, assure that the training/evaluation occur, the quorum is acceptable, and every staff had active participation in the discussion and trainings.
The 24 hours may include two (2) hours on Prevention of Medical Errors. HIV/AIDS is now a one-time, 1-hour CE requirement to be completed prior to the first renewal. Elder Affairs Alzheimer's training is mandatory course (1 and 2 hours traininng) Domestic Violence (DV) CE is now a 2-hour requirement every third renewal. Since Domestic Violence (DV) is a 2-hour requirement, the licensee will have 26 hours of CE during the renewal period when DV is taken. For example, if you renew your license on July 31, 2018 and completed DV during the 2016-2018 licensure cycle, you are required to complete the Domestic Violence CE before the July 31, 2024 renewal.
CPR: must be current (not on-line training)
All home health aides employed by home health agencies must complete an HIV/AIDS training course. They also are required to obtain and maintain a current certificate in cardiopulmonary resuscitation (CPR). Home health aides employed by Medicare and Medicaid home health agencies are required to have a total of 12 hours of in-service training during each 12-month period (this can be a calendar year or based on the date of hire, and may be done by qualified RN agency's staff). The HIV/AIDS training and CPR training may be counted toward meeting the 12 hours of in-service training.
All CNAs must complete a minimum of 12 hours of in-service training each calendar year. Every 2 years, in-service training hours shall include, but are not limited to, the following areas: Bloodborne Pathogens, Infection Control, Domestic Violence, Medical Record Documentation and Legal Aspects Appropriate to Nursing Assistants, Resident Rights, Communication with cognitively impaired clients, CPR skills, Medical Error Prevention and Safety
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