Human Resources Duties of the Agency

Staff Application Pack

(For all disciplines)

(Minimum order 5 / discipline)

Ready to use, updated as required, only $ 2.59 each

Your License must be renewed every 2 years

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

Training In your Office

Every month your Agency must comply with the in-office training to your staff.

Staff Competency Program:

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.

New Statement Background Screening (2024)  Bckg Screening 

Staff Agreement: Staff Agreement Community Liaison Agreement Agreement

Clinical Manager JD (Add to DON):  Job Description

QAPI staff Job Descrip.  Job Description    DON Job Desc:    DON JD

Compliance Officer  Job Description  New Alzheimer's InfoAlz.Info Administrator Clarification:  Administrator JD add (add to Administrator JD)

All Agency Job Descriptions:    Job Descriptions

Staff Family Medical Leave Request Leave Request

Inactive/Active Staff:  Inactivation Form

Staff Chart Audit Form (at least Annually to all field and office staff):

Staff Chart Audit Form                 Staff Chart Audit Form (Non field staff)

Every year all the following reports must be completed under the supervision of the Agency's Administrator or Human Resources Manager.

ADMINISTRATOR/HR: Staff Chart Audit Result Report to BD (Quarterly):

Quarterly Report for Chart Audits presented to BD meeting  

Staff Chart Audit Report BD

If needed, to complete competencies for Professional Staff (PT, OT, ST, MSW), the Agency need a participation of a member of the same discipline, if no staff is available, the Agency must contract a same discipline member Consultant to do the competencies in any discipline needed:

Prof. Consultant Contract (External contract, if needed for competencies)

Initial prospective staff Interview                      Exit staff Interview

Initial Interview                                                Exit Interview

Disciplinary warning:  Staff warning   Software Secury:Software Security

Staff survey: Staff Survey  Staff Concern/report incident: Staff Concern

Staff suspect Abuse, Neglect, Fraud report: Staff Abuse Report

During Absence of Administrator Form               During Absence of DON Form

(This forms must be filed in each chart Administrator/DON and their alternates)

During Absence Administrator                        During Absence of DON

Position Change Staff Orientation                   New DON Orientation

(all staff in new position must be trained/oriented in their new duties)

Position Change Orientation                            DON Orientation

New Alt. DON Orientation                                 QAPI Staff Orienattion

Alt. DON Orientation                                         QAPI Orientation         

Supervisor Staff Training/Orientation          Staff anonymous complaint

Supervisior Training Form                               Staff Complaint

Electronic Signature Authentication

Staff who sign electronically           Electronic Health Record Staff Access Auth.

Electronic Signature Authentication            Electronic HR Authorization

ARTIFICIAL INTELLIGENCE USE Auth. (AI)  AI User Access Authorization

School Verification if Diploma not available (CHAP only required)

(CHAP Only, not necessary if it is prevented by your Policy)

School Diploma Verification                           Personnel Licensure Policy

STTAF EVALUATIONS:  

90 days/Probation Period        (Same for all disciplines)

90 Days/Probation period:  Probation period eval

Annual Evaluations:          

Executive Staff Evaluations:

Administrator Competency                            Alt. Administrator Competency

DON Evaluation                                              ADON Evaluation

Field Staff:

Registered Nurse or Licensed Practical Nurse      Home Health Aide (HHA or CNA)

RN or LPN Annual Evaluation                        HHA or CNA Annual Evaluation

Psychiatric/IV/Pediatric Nurse, you must add this competency (Initial/Annual):

Pshyc RN Compentency                                IV Therapy Compentency

Pediatric RN Compentency                            Chemotherapy Compentency

Physical Therapist or Assistant                       Occupational Therapist or Assistant

Physical Therapist or Assistant                       OT or OTA Annual Evaluation

Speech Therapist or Assistant                          Social Worker

ST or STA Annual Evaluation                          MSW Annual Evaluation

Glucometer Competency                          

 (Nursing Staff-Annual)       The patient's glucometer must be verified before to be used staff:                               

Glucometer 2 Competencies                       Glucometer use verification 

( Also must have literature about the Glucometer manufacturer guidelines)

CoaguChek PT-INR Tests (Nursing Staff-Annual)

 CoaguCheck Competency 1                         CoaguCheck Competency 2

Bag Technique Competency                 Hand Hygiene knowledge assessment

(Initial-Annual)                              (all field staff)                   (Initial-Annual)               

Bag Technique Competency                        Hand Hygiene Knowledge    

 Handwashing (initial/Annual):  Handwashing Competency

Hand Hygiene Staff Survey      Hand Hygiene Staff Survey (annual)

Bag tech., Pt Assessment, Handwashing procedures documentation:

Bag Assesment/Handwashing   (share with your staff)           

Yearly BP Gauges Check Log          Vissual Inspection of BP Equipment

BP Gauges Check Log  (annual)                  BP equipment inspection

Cardiovascular Disease Best Practice Competency CVD Competency

(AI) Artificial Intelligence Annual Competency Checklist (AI) Competency

TB risk assessment questionnaire:  TB risk assessment questionnaire

Non Clinical staff:

Office Staff (Non-Clinical Staff)                        Safety Culture  Survey (all staff)

Non-Clinical Annual Evaluation                   Safety Culture survey                      

EXTRA training, after defficiency detected, after Survey Staff training form (generic form to be completed as proof of training received after deficiency noted on patient complaint, supervision or during survey)

Staff Training after defficiency   (part of the defficiency correction POC)

ADMINISTRATOR: Influenza Vaccine Rate Compliance Goal LOG

(must be posted in the Agency's Board)           (Initial-Annual)   

Influenza Vaccine Goal Log                       Influenza Staff data

ADMINISTRATOR/HR: Staff Influenza Declination Analyzes, Report to BD (Quarterly):

Influenze Declination Analyzes

CALENDAR of In-services (must be posted in the Agency's Board)

Calendar of In-services

STTAF VERIFICATIONS:  

Florida Verify License:  

(Prof. staff & referral physicians)   OIG (Office Inspector General

                                                                                              (at hire/monthly)       

FL Prof. License  (at hire/annual)   OIG Verify Medicare Exclusion  

Sex Offender: (at hire)                    AHCA  Background Screening         
Sex Offender Registry              AHCA Background Screening

E-Verify:  E-Verify-Legal Status  Verification Multi-State License:  License

Florida School Verification (Verify that the School is Licensed)

FL School Verification              

Live Scan Providers: Live Scan Providers (for background check)

Florida:  Alzheimer's Educator Registration App:         Alzheimer's Educator

Approved Schools/trainer: Alzheimer's Schools   HCAF Approved Training

Texas:                                                Pennsylvania:

TX Verify License                       PA Verify License

Driver License check:
FL Drive License Check             TX Background Screening          

TX Driver License Check           PA Background Check

 PA Drivers License Check

New CoPs:  HHA/CNA Competency  (new practical part)

Disclaimer: Every template is only your Guide/Agenda to complete each report, your Agency Officials must assure that the meeting/evaluation occur, the quorum is acceptable, and every member had active participation in the discussion and confection of the Reports, Evaluations/Competencies, Documents.

The 24 hours may include two (2) hours on Prevention of Medical Errors. HIV/AIDS is now a one-time triningl. 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 (lifetime), Elder Affairs Alzheimer's training must be completed (1 and 2 hours). They also are required to obtain and maintain a current certificate in cardiopulmonary resuscitation (CPR) not on-line.  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).  The HIV/AIDS training and CPR training may be counted toward meeting the 12 hours of in-service training. The Home Health Agency qualified RN can provide that training monthy. Material for trainig at https://homecareoffice.com/StaffTraining.htm

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