Admissions Packet
Table of Contents
Client Handbook
Emergency Phone Numbers
Welcome
Who Are We?
How Can You Contact Us?
What are Our Hours of Operation?
What is Our Mission, Our Vision, Our Values?
What are Our Ethical Practices?
What is Our Philosophy on Service Delivery?
What are Our Professional Boundaries?
What are Your Rights & Responsibilities?
What are Our Responsibilities?
What Services Do We Offer?
What Services Don’t We Provide?
What Insurance Coverage Do We Carry?
Who Can Benefit from Our Services?
What are Our Admittance Criteria?
Can You Be Re-Admitted After Termination/Discharge
What are Our Service Rates?
What are Our Billings & Payment Policies?
Who Pays for Your Service Costs?
What are Our Staffing Practices?
How Do We Set-Up Your Services?
How Do We Handle Communication Challenges?
How Do we Manage Your Service Delivery?
What Information Do We Keep in Your Records?
How Do We Manage Your Confidential Information?
What is Protected Health Information?
What is a “Notice of Privacy Practices”?
How Do We Determine Your Satisfaction Level?
How Do You File a Complaint?
What is Advance Care Planning?
How Do We Manage “Do Not Resuscitate” Orders?
What Constitutes Elder Abuse?
What Constitutes Child Abuse?
How to Protect Your Personal Safety
How to Protect Yourself at Home
What to Do in a Medical Emergency
How to Deal with Non-Emergency Medical Issues
How to Guard Against Infections
What to Do in Hazardous Situations
What to Do During Natural Disasters
What is the “Federal False Claims Act”?
Addendums
Acknowledgement: Receipt of Admissions Packet
Advance Directives – Canada
Advance Directives – US
Client Care Flow Sheet
Client Consent for Referral & Release of Information
Client Progress/Communication Notes
Client Service Certification Record
Complaint Fax Form – OIG Hotline
Complaint/Grievance Form
Emergency Preparedness for Seniors Booklet
Emergency/Disaster Procedures – FEMA
Emergency – Family Communication Plan
HIPAA – Acknowledgment of Receipt of Notice of Privacy Practices
HIPAA – Authorization for Use or Disclosure of Health Information
HIPAA – Notice of Privacy Practices
Medication Administration Record
Medication Profile
Non-Emergency Medical Travel Booklet for Beneficiaries
Notice of Direct Care Worker Status – Agency Employee
Notice of Direct Care Worker Status – Non-Agency Employee
Statement of Privacy – CMS-OAS
Plan of Care
Service Agreement –Client & Agency
Service Information Handout for Clients