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LOGS: Be organized

Training In Our Office

Describe the photo or the page it links to

Every semester we offer 1 or 2 in-office training to your employees.


Medical Record: Clinical Record Entry Log: Clinical Record entry Log

(by authorized staff only)

DON: Referral Log (Admitted / Non Admission): Referral Log


DON: High Risk/Alert Medication LOG (This log document the control of High Alert Medications)

High Alert/Risk Medications


DON: Medication Reconciliation LOG (This log document the Medication reconciliation)

Medication Reconciliation

Medication/Drugs/Supplies list:

DON: Sound/Look alike:             Supplies Inventory/Cleaning Storage               

 Sounds/Looks Alike               Supplies Inventory/Cleaning Storage                

DON: Fall Injury review tool LOG

Fall Injury Review Tool (as needed)     Monthly Fall Tracking (Monthly)


DON: Infection Prevention & Control program (Data Control List) LOG (Must be completed monthly)

Infection Control Log       Prevention/Tx Log: Infection Prevention/Tx


DON: Hospitalization LOG (Must be completed monthly)

Hospitalization Log

DON: Patient on OXYGEN therapy LOG (Must be completed quarterly)

Patients on Oxygen Log


DON: Coordination of Care Compliance/Tracking LOG (Quarterly)

Coordination of Care

Ass needed:

ON CALL:  Report: ON Call Report     On Call Log/Calendar: ON Call Log

            Visitor Log: Visitor Log    (Front desk clip board)

Administrator/DON: Emergency Control Log (Monthly)  Hazard Vulnerability

Emergency Control Log

Hazard Vulnerability Analyzes

Hazard Vulnerability Log

Administrator/DON: Safety Tracking LOG (All year long)

Safety Tracking Log


Administrator/DON: Complaints Log (Monthly)

Complaints Log Summary                    Complaints Log (detail) Summary


Complaint, ON-CALL  report:  Complaints Report


Administrator/DON: Orders Movement Log (Monthly)

Orders Movement Log


 (Must be completed as applicable)

Accident Incident Report       

DON: FALL INCIDENT Report (Must be completed as applicable)

Fall Incident Report    


Medical Error Report

DON: SHARP INJURY INCIDENT Report (Must be completed as applicable)

Sharp Injury Incident Report    

Multiple incident report forms: Multiple  Incident Report forms 


Administrator/DON/QA: Total of Incidents Summary/Occurrence Report  (Monthly)

Incidents/Occurrence Report

Administrator/DON: Following Policy LOG (all department of the Agency must follow Policy and Procedures, this log document the compliance)

Following Policy log

Administrator/DON/QA: Patients Survey Summary Table Analyzes (Quarterly)

Patients Survey Form                 Results of Patients survey analyzes, possible Adverse Event

Patients Survey Summary                 Adverse Event Patient Survey

DON: Adverse Event Incident Report Form: (if needed, fall, severe patient's health impact, etc.)

Adverse Event Incident

Administrator: Extinguisher Log (Monthly-Yearly)

Extinguisher Maintenance Log


Administrator: Visitor Log (all year long, front desk)

Visitor Log


Disclaimer: Every log template is only your Guide/Agenda to complete each log, your Agency Officials must assure that every member had active participation in the discussion and confection of the Log, Reports, Evaluations, Documents.



This service reflects the author’s own opinions about Home Health Care services. Although the information and Policies are from sources deemed very reliable, they are not guaranteed. PN System © owner disclaims any personal liability for loss incurred as a result of the applications of any information offered in this application process, or in the use of our services. If expert, professional, medical, clinical assistance is required, the services of a component professional person should be sought. Your Director of Nursing, MUST review/approve the Policies / Procedures/ Forms.


Also you and your Agency guarantee to comply with all Federal/Local/State laws to use our services.

Please take a moment to comment about our services:


Customer Survey


We are Proud Member of the Home Health Association of Florida:


Over 20 years serving more than 2000 Home Health Agencies nationwide.


CHAP Certified Consultant

Joint Commission Education

CMS Education/Seminars

ACHC Education/Seminars

AHCA Education/seminars





(One Patient's Signature only)

Only $5.00 each

Minimal Order 25