Admissions Packet

Table of Contents


Client Handbook

Emergency Phone Numbers


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”?  



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