NON-MEDICAL HOME CARE:  FORMS PACKAGE-TOC

 

Table of Contents

 

 

MS Word Forms

 

  1. Advance Directives Information Sheet – CAD
  2. Advance Directives Information Sheet – U.S.
  3. Adverse Action: Pre-Action Disclosure
  4. Adverse Action: Disclosure
  5. Assessment: General Needs
  6. Assessment: Nursing
  7. Assessment: Personal Care
  8. Bomb Threat Checklist
  9. Care Plan/Service Plan (includes a Needs Assessment)
  10. Client Care Flow Sheet
  11. Client Care Notations
  12. Client Cash Transactions
  13. Client’s Consent for Referral & Release of Information
  14. Client Invoice: Individual    –  (MS Word)
  15. Client Invoices: Master Log – (MS Word)
  16. Client Medication Record
  17. Client Satisfaction Survey: Agency Services
  18. Client Satisfaction Survey: Direct Care Services
  19. Client Service Certification Record
  20. Client Service Schedule
  21. Communicating with People who have Disabilities
  22. Competency Test – Practical Skills for Care Aides
  23. Competency Test – Written Questions
  24. Competency Test – Answers & Composition
  25. Complaint/Grievance
  26. Confirmation of Service Delivery
  27. Conflict of Interest Statement
  28. Consent for Child Abuse Clearance Check
  29. Consent to Release Child Abuse Clearance Report
  30. Coordination of Care Check List
  31. Declination of Influenza Vaccination
  32. Discharge/Transfer Summary
  33. Discharge/Transfer: Client Notification
  34. Emergency Preparedness Plan
  35. Employee Compliancy Agreement: Policies & Procedures
  36. Employee Confidentiality & Non-Disclosure Agreement
  37. Employee Orientation Check List
  38. Employee Performance Appraisal
  39. Employee Reference Check
  40. Employee Time Sheet
  41. Employee & Employer Agreement
  42. Employment Candidate Interview
  43. Field Supervision Review
  44. Financial Expenditures on Client’s Behalf
  45. Home Safety Check List
  46. Identity Theft Prevention Program & Addendums
  47. Incident Report – General
  48. Incident Report – Medications
  49. Incident Report – Post Exposure to Blood-borne Diseases
  50. Incident Report – Post Exposure to Tuberculosis
  51. Incident Reporting Log
  52. Independent Contractor & Agency Agreement
  53. Job Description —  Home Care Assistant Model
  54. Job Description —  Home Care Companion
  55. Job Description —  Home Care Manager/Administrator
  56. Job Description —  Home Care Personal Care Attendant
  57. Job Description — Home Care Registered Nurse
  58. Job Description —  Home Care Supervisor
  59. Job Description —  Homemaker
  60. Job Description —  Live-In Home Care Aide
  61. Job-Employment Application
  62. Market Analysis for Home Care Business
  63. Medication Administration Record
  64. Mission, Vision & Value Statement
  65. Notations re Client Care
  66. Notification of Direct Care Worker Status – Agency Employee
  67. Notification of Direct Care Worker Status – Non-Agency Worker
  68. Organizational Chart
  69. Personal Care Supplies Check List
  70. Personal or Private Vehicle Usage Mileage Record
  71. Personal Suitability Questionnaire
  72. Phone Numbers – Emergency
  73. Pre-Employment Background Check Authorization
  74. Reference Checks
  75. Request or Decline a Hepatitis B Vaccine
  76. Rights & Responsibilities of Client & Agency
  77. Service Agreement (Client & Agency)
  78. Service Information Handout for Clients/Consumers
  79. Special Equipment Check List
  80. Staff Record of Training & In-Services
  81. Standards of Conduct
  82. Start-Up Work Plan Check List
  83. Transportation Liability Waiver

 

 

MS Excel Forms

  1. Financial Projection Model: An All-in-One File containing Excel Worksheets for projecting:
  2. Start-Up Funds
  3. Salaries & Wages
  • Fixed Operating Expenses
  1. Projected Sales Forecast
  2. Projected Sales (Year 2)
  3. Cash Receipts Disbursements
  • Income Statement
  • Cash Flow Statement
  1. Balance Sheet
  2. Year End Summary
  3. Income Projection Statement (Year 2)
  • Cash Flow Statement (Year 2)
  • Balance Sheet (Year 2)
  • Income Statement (Year 3)
  1. Cash Flow Statement (Year 3)
  • Balance Sheet (Year 3)
  • Financial Ratios (Years 1, 2 & 3)
  • Breakdown Analysis
  • Amortization Schedules
  1. Financial Diagnostics
  2. Financial: Profit & Loss Statement – Excel Worksheet