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Pandemic Agency Documentation

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COVID-19 (Coronavirus Agency relief effort)   ***** NO LONGER MANDATORY AFTER 05/11/2023

The following templates, must be used for the Agency Pandemic Management Plan documentation

Vaccination full package: Covid-19 Vaccination Package              ACHC Approval

Pandemic Management Plan:       CMS Guidelines Coronavirus         Vaccination Policy       Mask Use guidelines

Pandemic Mgm Plan                      Coronavirus CMS guidelines          Vaccination Policy       Mask Use

Vaccine Info:  Vaccine English info            Vaccine Spanish info               Total staff vaccination report 

Staff Vac. Attestation:  Vaccine attestation          Staff vaccination log control: Vaccine log control

Vaccine Medical Exeption: Vaccine Medical Exp.    Religious Exeption: Vaccine Religious Exep.

Emerging Infections Disease Policy: EID Policy       Covid-19 Policy: Covid-19 Policy

Contingency Plan for ALF, Nursing Home staff testing:  Contingency Plan

Letter to staff on restricted areas: Letter to Staff        Bio Waste Disposal:  Disposal        

Goverment COVID-19 resources Covid-19         ACHC COVID-19 resources Covid-19

           CHAP COVID-19 resources Covid-19        JCHO COVID-19 resources Covid-19

 Emerging Infectious Disease (EID) report                            

EID Report   (forward copy to Board of Director & Infection Prev. Committee - monthly)            

Assessing Covid-19 Risks in the Workplace (monthly): Staff Risk Report 

Preventing Nosocomial COVID‐19 Infections: Preventing Nosocomial Infections   (monthly)

Pandemic Management Plan Compliance Report (Ibfection prevention) Pandemic Infec. Prev. Report    Monthly

Pandemic Log Control:  Patients           Staff

Caring for COVID-19 Patient documentation  Caring for Covid19 documentation  (Add to progress note)

Staff Weekly Screening Protocol:  WeeKly Screening     (must be completed daily to all Agency visitors)

Pandemic screening tool (patients):   Pandemic Screening   (must be complete weekly for patient/staff)

Caring for COVID-19 Patient guide (CHAP)  Caring for Covid19

Pandemic Agency Actions                                          Pandemic Response Roles

Pandemic Actions                                                       Pandemic Roles

Pandemic Infection Prevention                               Pandemic Home Care Planning

Pandemic Infection Prev.                                           Pandemic Agency HC planning report  

Covid-19 QAPI Report (Quarterly):  COVID-19 PI Report

Person Under Investigation (PUI) and Case Report Form:  Coronavirus PUI                             

COVID-19 Resources        National Emergency Waivers:  2023 Waivers         CHAP Video waivers    FL Waivers

We encouraging organizations (CHAP and non-CHAP accredited) to participate in CHAP weekly COVID-19 conference calls. They have those calls on Tuesdays at 10:30 AM EST, Wednesday at 11:00 AM EST, and Thursday at 3:00 PM EST.  The call in number is 646-307-1479, participant code 246854#.  In addition, CHAP have a COVID-19 hotline for immediate questions 202-862-3416 (Monday-Friday 8:30 AM-5:30 PM EST).

CHAP Video: COVID19 tips              Patient/family Instructions: COVID19 English        COVID19 Spanish

JCHO Surveys Video: COVID19       CDC Infection prevention recommendation  CDC video

ACHC Instructions  COVID19           General Instructions Posters:  Poster English        Poster Spanish

Covid-19 Pamplet for your Staff and Patients Covid-19 Pamplet  $ 1.25 each, minimal order 25


Disclaimer: Every template is only your guide to complete Pandemic Management Documentation, your Agency Officials must assure that task were completed, the quorum is acceptable, and every member had active participation in the discussion, activities.