Staff Application Pack
(For all disciplines)
(Minimum order 5 / discipline)
Ready to use, updated as required, only $ 2.59 each
(For all disciplines)
(Minimum order 5 / discipline)
Ready to use, updated as required, only $ 2.59 each
Renew License Form: 60 days before to expiration date. CLIA application form
Every month your Agency must comply with the in-office training to your staff.
Staff Competency Program:
PRIVACY AND SECURITY NOTICE REGARDING ELECTRONIC
FORMS. Our electronic forms are provided
solely as a convenience to assist Home Health Agencies in completing
required documentation. The forms operate within your web browser and are
intended for local use by authorized agency personnel. No patient
information entered into these forms (if any) is collected, stored, saved,
transmitted, processed, or retained by our website, servers, or systems. The
information entered remains under the control of the user and is used only
to generate or complete the form for the agency's own records. Because no
protected health information (PHI) is received, maintained, saved, or
retained by our website, we do not create or maintain a database of patient
information from these forms. This website is protected by a valid HTTPS
Secure Sockets Layer (SSL/TLS) certificate, which encrypts communications
between your web browser and our website to help protect the integrity and
security of your connection. Home Health Agencies remain solely responsible
for ensuring that any completed forms are handled, stored, transmitted,
printed, or incorporated into their medical, administrative record systems
in compliance with all applicable federal and state laws, including the
Health Insurance Portability and Accountability Act (HIPAA), the Health
Information Technology for Economic and Clinical Health (HITECH) Act,
applicable Centers for Medicare & Medicaid Services (CMS) Conditions of
Participation, and any other applicable state and federal privacy and
security requirements. By using these electronic forms, users acknowledge
that they are responsible for maintaining the privacy, security, and
confidentiality of any patient information after the form has been
completed. Please Note: While this website uses industry-standard HTTPS
(SSL/TLS) encryption to secure communications, HIPAA compliance ultimately
depends on how each Home Health Agency uses, stores, transmits, and
safeguards Protected Health Information (PHI) after the form has been
completed.
New Statement Background
Screening (2024)
Bckg Screening
Staff Agreement: Staff Agreement Community Liaison Agreement Agreement
Clinical Manager JD (Add to DON): Job Description
QAPI staff Job Descrip. Job Description DON Job Desc: DON JD
Compliance Officer
Job
Description New Alzheimer's InfoAlz.Info
Administrator Clarification:
Administrator
JD add (add to Administrator JD)
All Agency Job Descriptions: Job Descriptions
Staff Family Medical Leave Request Leave Request
Inactive/Active Staff: Inactivation Form
Field staff Transportation Arrangement attestation Transportation (used when a field staff doesn't hold a valid driving license, and will use a designated driver)
STAFF AFFIDAVIT PROHIBITION OF PROVIDE SERVICES TO A FAMILY MEMBER Family
Staff Chart Audit Form (at least Annually to all field and office staff):
Staff Chart Audit Form Staff Chart Audit Form (Non field staff)
ADMINISTRATOR/HR: Staff Chart Audit Result Report to BD (Quarterly):
Quarterly Report for Chart Audits presented to BD meeting
If needed, to complete competencies for Professional Staff (PT, OT, ST, MSW), the Agency need a participation of a member of the same discipline, if no staff is available, the Agency must contract a same discipline member Consultant to do the competencies in any discipline needed:
Prof. Consultant Contract (External contract, if needed for competencies)
Initial prospective staff Interview Exit staff Interview
Initial Interview Exit Interview
Disciplinary warning: Staff warning Software Secury:Software Security
Staff survey: Staff Survey Staff Concern/report incident: Staff Concern
Staff suspect Abuse, Neglect, Fraud report: Staff Abuse Report
During Absence of Administrator Form During Absence of DON Form
(This forms must be filed in each chart Administrator/DON and their alternates)
During Absence Administrator During Absence of DON
Position Change Staff Orientation New DON Orientation
(all staff in new position must be trained/oriented in their new duties)
Position Change Orientation DON Orientation
New Alt. DON Orientation QAPI Staff Orienattion
Alt. DON Orientation QAPI Orientation
Supervisor Staff Training/Orientation Staff anonymous complaint
Supervisior Training Form Staff Complaint
Electronic Signature Authentication
Staff who sign electronically Electronic Health Record Staff Access Auth.
Electronic Signature Authentication Electronic HR Authorization
ARTIFICIAL INTELLIGENCE USE Auth. (AI) AI User Access Authorization
School Verification if Diploma not available (CHAP only required)
(CHAP Only, not necessary if it is prevented by your Policy)
School Diploma Verification Personnel Licensure Policy
STTAF EVALUATIONS:
90 days/Probation Period (Same for all disciplines)
90 Days/Probation period: Probation period eval
Annual Evaluations:
Executive Staff Evaluations:
Administrator Competency Alt. Administrator Competency
DON Evaluation ADON Evaluation
Field Staff:
Registered Nurse or Licensed Practical Nurse Home Health Aide (HHA or CNA)
RN or LPN Annual Evaluation HHA or CNA Annual Evaluation
Psychiatric/IV/Pediatric Nurse, you must add this competency (Initial/Annual):
Pshyc RN Compentency IV Therapy Compentency
Pediatric RN Compentency Chemotherapy Compentency
Physical Therapist or Assistant Occupational Therapist or Assistant
Physical Therapist or Assistant OT or OTA Annual Evaluation
Speech Therapist or Assistant Social Worker
ST or STA Annual Evaluation MSW Annual Evaluation
Glucometer Competency
(Nursing Staff-Annual) The patient's glucometer must be verified before to be used staff:
Glucometer 2 Competencies Glucometer use verification
( Also must have literature about the Glucometer manufacturer guidelines)
CoaguChek PT-INR Tests (Nursing Staff-Annual)
CoaguCheck Competency 1 CoaguCheck Competency 2
Bag Technique Competency Hand Hygiene knowledge assessment
(Initial-Annual) (all field staff) (Initial-Annual)
Bag Technique Competency Hand Hygiene Knowledge
Handwashing (initial/Annual): Handwashing Competency
Hand Hygiene Staff Survey Hand Hygiene Staff Survey (annual)
Bag tech., Pt Assessment, Handwashing procedures documentation:
Bag Assesment/Handwashing (share with your staff)
Yearly BP Gauges Check Log Vissual Inspection of BP Equipment
BP Gauges Check Log (annual) BP equipment inspection
Cardiovascular Disease Best Practice Competency
CVD Competency
(AI) Artificial Intelligence Annual Competency Checklist (AI) Competency
TB risk assessment questionnaire: TB risk assessment questionnaire
Non Clinical staff:
Office Staff (Non-Clinical Staff) Safety Culture Survey (all staff)
Non-Clinical Annual Evaluation Safety Culture survey
EXTRA training, after defficiency detected, after Survey Staff training form (generic form to be completed as proof of training received after deficiency noted on patient complaint, supervision or during survey)
Staff Training after defficiency (part of the defficiency correction POC)
ADMINISTRATOR: Influenza Vaccine Rate Compliance Goal LOG
(must be posted in the Agency's Board) (Initial-Annual)
Influenza Vaccine Goal Log Influenza Staff data
ADMINISTRATOR/HR: Staff Influenza Declination Analyzes, Report to BD (Quarterly):
Influenze Declination Analyzes
CALENDAR of In-services (must be posted in the Agency's Board)
STTAF VERIFICATIONS:
Florida Verify License:
(Prof. staff & referral physicians) OIG (Office Inspector General
(at hire/monthly)
FL Prof. License (at hire/annual) OIG Verify Medicare Exclusion
Sex Offender: (at hire)
AHCA Background Screening
Sex Offender Registry
AHCA Background Screening
E-Verify: E-Verify-Legal Status Verification Multi-State License: License
Florida School Verification (Verify that the School is Licensed)
Live Scan Providers: Live Scan Providers (for background check)
Florida: Alzheimer's Educator Registration App: Alzheimer's Educator
Approved Schools/trainer: Alzheimer's Schools HCAF Approved Training
Texas: Pennsylvania:
TX Verify License PA Verify License
Driver License check:
FL Drive License Check
TX Background Screening
TX Driver License Check PA Background Check
New CoPs: HHA/CNA Competency (new practical part)
Disclaimer: Every template is only your Guide/Agenda to complete each report, your Agency Officials must assure that the meeting/evaluation occur, the quorum is acceptable, and every member had active participation in the discussion and confection of the Reports, Evaluations/Competencies, Documents.
Staff Licensure, Continuing Education, and Required Training—This is staff duty, not agency responsibilities.
License verification and responsibility
Licensed and certified personnel are responsible for maintaining their credentials and completing their profession’s renewal requirements. The Agency remains responsible for verifying authorization to practice, documenting required employment training and competency, and monitoring expiration dates.
A license showing Clear/Active supports verification of current licensure; it does not, by itself, establish completion of all agency-specific orientation, annual in-service education, CPR, dementia training, or competency requirements.
LPNs, RNs, and APRNs
Florida nursing licenses generally renew biennially. Unless an exemption or special renewal provision applies, LPNs and RNs must complete 24 contact hours of appropriate continuing education per renewal period, including:
Two hours in Prevention of Medical Errors each renewal.
Two hours in Florida Laws and Rules each renewal.
Two hours in Human Trafficking each renewal.
Two hours in Recognizing Impairment in the Workplace every other renewal.
One hour in HIV/AIDS before the first renewal—a one-time requirement.
Two hours in Domestic Violence every third renewal, in addition to the regular 24 hours, generally resulting in 26 hours for that renewal.
APRNs must also meet applicable advanced-practice requirements, including three hours in Safe and Effective Prescription of Controlled Substances. Specialty-certification exemptions and first-renewal provisions must be evaluated individually. “APRN” replaces the former designation “ARNP.” Florida Board of Nursing requirements, RN renewal requirements
Therapists
Therapists must meet their own board’s renewal requirements. A single 24-hour requirement does not apply to all therapy disciplines. Standard biennial requirements generally include:
Physical therapists and physical therapist assistants: 24 contact hours.
Occupational therapists and occupational therapy assistants: 26 contact hours.
Speech-language pathologists: 30 contact hours.
Required subjects, acceptable course formats, exemptions, and first-renewal requirements vary by profession. Physical Therapy Board, Occupational Therapy Board, Speech-Language Pathology Board
Certified Nursing Assistants
Florida CNAs generally must complete 24 hours of in-service training during each biennium, rather than a universal Board requirement of 12 hours each calendar year. Required subjects include bloodborne pathogens and infection control; domestic violence; documentation and legal aspects appropriate to nursing assistants; resident rights; communication with cognitively impaired clients; CPR skills; and medical-error prevention and safety.
CNAs must also satisfy the applicable paid nursing-related work requirement for renewal. The Agency must separately meet annual training requirements applicable to CNAs working as home health aides. Florida Board of Nursing CNA renewal and in-service requirements
Home Health Aides and Annual In-Service Education
Home health aides are not licensed by the Florida Department of Health. The Agency must verify their qualifications, training, and competency.
Florida home health agency rules require HHAs and CNAs to receive in-service education each calendar year. Where 42 CFR 484.80 applies, an aide must receive at least 12 hours during each 12-month period. A CNA working as a home health aide must meet the applicable aide requirements in addition to maintaining CNA certification.
Federal aide in-service education must be RN-supervised, and the Agency must maintain supporting records. Monthly sessions may be used to meet the requirement, but the federal rule does not require a monthly schedule. Establish a consistent tracking period and ensure required hours are completed within it. Florida personnel rule, 42 CFR 484.80(d)
HIV/AIDS Training
Home health agency employees covered by Rule 59A-8.0095(5)(r) must complete a one-time HIV/AIDS education course within 30 days of employment. Employees subject to the professional HIV/AIDS requirements of section 456.033 follow those requirements. Retain evidence of prior qualifying completion when applicable. This one-time requirement does not eliminate other infection-control or occupational-exposure training obligations. Florida personnel rule, Section 456.033
Alzheimer’s Disease and Related Dementias Training
For covered home health agency personnel:
Provide required basic written dementia information upon employment.
Employees providing personal care or having regular patient contact must complete the Department of Elder Affairs’ one-hour training within 30 days.
Employees providing personal care must complete an additional two hours of approved training within seven months.
Document applicable prior-training credit or exemptions. Additional training must meet Department requirements for the care setting and approved trainer/curriculum. Section 430.5025, Department of Elder Affairs guidance
CPR
HHAs and CNAs must maintain current CPR certification meeting Florida home health agency requirements. Require an approved course with an in-person demonstration of CPR skills. A blended course may include online instruction; an online-only certificate without the required skills demonstration is insufficient. Other personnel must meet applicable professional, payer, accreditation, and Agency requirements. Florida personnel rule, amended effective May 31, 2026
Do not automatically count CPR or HIV/AIDS training toward every education requirement. Credit depends on the applicable standard, course content, documentation, and reporting period. CPR/BLS certification and recertification do not count toward nurses’ routine license-renewal CE requirement. Florida Board of Nursing guidance
Training Resources (Agency Duty)
Training materials are available at HomeCareOffice Staff Training. Before awarding credit, verify that the course, instructor, curriculum, and documentation satisfy the specific requirement. Availability on a website does not establish Board or Department approval.
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