Annual Duties of the Agency

Emergency Plan

Same month every year (annually)

Complete the Data Sheet.

Complete the Agreement with another Agency. (Fax to us the information to complete/submit the Plan)

Your License must be renewed every 2 years

Renew License Form: 60 days before to expiration date.    CLIA application form

Every year all the following reports must be completed under the supervision of the Agency's Administrator and/or Director of Nursing (REMEMBER Open all new Year LOGS):

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)

Strategic Plan           

Risk Management Plan          Drug Free Workplace program            

Risk Mgm Plan                               Drug Free Program                          

Contracts Annual Evaluations:

Every Agency's Contract must be evaluated

every year, including 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  (CHAP only)

Administrator: Three (3) years budget (current year + next 2 years)

Budget. Sample                       OSHA’s Form 300  Osha's 300  (Must be printed, even if not accidents)

HIPAA Implementation plan           Workplace Violence Annual report

HIPAA Implementation Eval            Workplace Violence Eval

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    Risk Assessment Report for Infection Surveillance, Prevention and Control  Risk

 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)

PI Annual Report                      QAPI Self Assessment tool: QAPI Annual self assessment Report

Anti-coagulants Safety Annual Report:   Anti-coagulants Annual Report

Dementia Care Program Annual Evaluation Dementail Annual Report

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

Survey Ready Check List

Agency Program Evaluation: (Voluntary) no longer mandatory after 01/13/2018

Agency Annual Evaluation

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.