Employee Name: - Home Health Forms
Employee Name: ________________________
Date: __________________________________
|Date |Initials |Subject |
| |n/a |Section I Getting Started |
| | |Name Badges |
| | |Chain of Command |
| | |Agency Services |
| | |Vision and Mission Statement |
| |n/a |Section II Human Resources |
| | |Employee Handbook |
| | |Acknowledgment of Employee Handbook (Sign and Return) |
| | |Drug, and Alcohol abuse (Sign and Return) |
| | |Employee Supervision & Continuing Education Requirements |
| | |Inventory Checklist (Sign and Return) |
| | |Professional Agreement Addendum (Sign and Return) |
| | |Policy and Procedure Manual Agreement (Sign and Return) |
| | |Performance Evaluations (Skills Checklist Must Insert) |
| | |Agreement to Arbitrate Employment (Sign and Return) |
| | |Conditions of Employment (Sign and Return) |
| | |Direct Deposit Form (Sign and Return) |
| |n/a |Section III Office Policies |
| | |Coverage Map |
| | |Office Policy and Procedural Manual |
| | |Fax Cover Sheet |
| | |Intake Referral Sheet |
| | |Visit Time Sheet |
| | |Complaint Form |
| | |Release of Information |
| | |Release of Information Authorization |
| |n/a |Section VI New Patient Admissions |
| | |New Admit Packet Part A |
| | |Chart Organization |
| |n/a |Section VII Infection Control |
| | |Blood-Born Pathogens |
| | |Infection Control Policies and Procedures |
| | |MRSA |
| | |Exposure Report (Sign and Return) |
| | |Hepatitis B Training |
| | |Hepatitis B Declination (If Hepatitis is declined Sign and Return) |
| | |Home Care Bag Procedures |
| | |Maintaining Equipment in the Car |
| | |Equipment Cleaning |
| | |Spills in the home |
| | |Tuberculosis |
| |n/a |Section VIII CLINICAL INFORMATION |
| | |Nursing Policy and procedural Manual |
| | |Abbreviations |
| | |Missed Visit Report |
| | |Physician Telephone Orders |
| | |Communication |
| | |Wound Care Form |
| | |HHA Care Plan |
| | |60 Day Summary |
| | |Case Conference |
| | |MAR |
| | |Documentation Rules |
| | |Nurses Documentation Bible |
| | |POC COP |
| | |SN COP |
| | |HHA COP |
| |n/a |Section IX Location of Teaching guides and Reference Materials |
| | |Office P&P |
| | |Nursing P&P |
| | |Drug Guide |
| | |ICD-9 Coding |
| |n/a |Section X Safety |
| | |Fire Extinguisher Locations and Usage |
| | |MSDS Manual Location |
| | |Eye Wash Station Location |
I was educated on the forms/topics listed above during orientation process and
I, ____________________________ understand and agree to abide by the
(please print)
policies and procedures set forth by YOUR COMPANY NAME HERE.
Employee Signature _______________________________________ Date__________________
Administrative Signature: ___________________________________ Date: _________________
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