Emergency Plan
Same month every year (annually)
Complete the Agreement with another Agency. (Fax to us the information to complete/submit the Plan)
Same month every year (annually)
Complete the Agreement with another Agency. (Fax to us the information to complete/submit the Plan)
Renew License Form: 60 days before to expiration date. CLIA application form
Every semester we offer 1 or 2 in-office training to your employees.
Administrator responsibilities:
Annual Agency's Strategic Plan (Must be discussed, approved
by the Board of Director in the Annual meeting at the
beginning of each year, the template must be updated with your
discussion and Agency's reality)
Risk Management Plan Drug Free Workplace program
Risk Mgm Plan Drug Free Program
Agency Program Evaluation: (Voluntary) no longer mandatory after 01/13/2018
Contracts Annual Evaluations:
Every Agency's Contract must be evaluated
every year, including with the Staffing Therapy Risk Management Annual Report:
Company, if applicable.
Contact Annual Evaluation Risk Management Annual Report
Administrator: CAPITAL EXPENDITURES PLAN must be evaluated/approval every year
Capital Expenditure Plan Accountant Ext. Rev. Sample
Administrator: Three (3) years budget (current year + next 2 years)
HIPAA Implementation plan must be evaluated every year.
Agency's Safety Program Implementation plan must be evaluated every year.
Safety Program Eval Annual Environmental Report
Director of Nursing responsibilities:
Infection Control Prevention and Control Annual Report, Infusion Therapy Summary, TB Risk Annual assessment:
Infection Control Annual Report Biomedical Waste Compliance
Bloodborne Pathogens Report Infusion Therapy Annual Report
TB Risk Annual Assessment Exposure Plan Annual review
Florida TB Statistics Texas TB Statistics California TB Statistics Illinois TB Statistics NJ TB Statistics
Performance Improvement Plan Annual Report (the template must be updated with your discussion and Agency's reality)
Intra-cycle Monitoring Process (JCHO only) Intracycle Monitoring (Self Assessment)
(At approximately 12 and 24 months after the Agency’s triennial survey)
Annual renew of your Emergency Plan: the same month every year (review your approval compliance letter)
Emergency Plan Data Backup Agreement signed with another Agency
Emergency Plan Emerg. Agreement
Bi-annual renew of the Agency License: Renew License Data CLIA: CLIA Renew
(at least 60 days before the expiration date)
Administrator/DON: Survey Ready Check List
Disclaimer: Every template is only your Guide/Agenda to complete each report, your Agency Officials must assure that the meeting occur, the quorum is acceptable, and every member had active participation in the discussion and confection of the Reports, Evaluations, Documents.
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