Staff IDs
$ 5.00 each
Staff Application Pack
(For all disciplines)
(Minimum order 5 / discipline)
Ready to use, updated as required, only $ 2.59 each
$ 5.00 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.
New CoPs: HHA/CNA Competency (new practical part)
Staff Agreement: Staff Agreement
Clinical Manager JD (Add to DON): Job Description
QAPI staff Job Description: Job Description DON JD: DON JD
Compliance Officer JD Job Description
Administrator Clarification: Administrator JD add (add to Administrator JD)
Staff Chart Audit Form (at least Annually to all field and office 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 if available, the Agency can contract a same discipline member Consultant to do the competencies in any discipline needed or for PAC member:
Prof. Consultant Contract (External non-employee 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
During Absence of Administrator Form During Absence of DON Form
(This forms must be filed in each employee 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 Job Descriptions
Alt. DON Orientation Job Descriptions
Supervisor Staff Training/Orientation Staff anonymous complaint
Supervisior Training Form Staff Complaint
School Verification if Diploma not available (CHAP)
(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:
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
Administrator Competency Alternate Administrator Competency
Administrator Competency Alt. Administrator Competency
Office Staff (Non-Clinical Staff) Safety Culture Survey
Non-Clinical Annual Evaluation Safety Culture survey
Glucometer Competency Handwashing
(Nursing Staff-Annual) (all field staff) (Initial-Annual)
Glucometer 2 Competencies Handwashing Competency
The patient's glucometer must be verified before to be used by your staff:
Glucometer use verification Also must have literature about the manufacturer guidelines
CoaguChek PT-INR Tests (Nursing Staff-Annual)
CoaguCheck Competency I CoaguCheck Competency II
Bag Technique Competency Hand Hygiene knowledge assessment
(Initial-Annual) (all field staff) (Initial-Annual)
Bag Technique Competency Hand Hygiene Knowledge
Bag technique, Patient Assessment, Handwashing procedures / staff training:
Yearly BP Gauges Check Log Hand Hygiene Staff Survey
(Annual)
BP Gauges Check Log Hand Hygiene Staff Survey
Visual inspection of BP equipment BP equipment inspection
Cardiovascular Disease Best Practice Competency CVD Competency
TB risk assessment questionnaire: TB risk assessment questionnaire
After Survey Staff training form (generic form to be completed as proof of training received after defficiency noted during a survey)
Staff Training after Survey (part of the Plan of 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
FL Verify License Verify Medicare Exclusion
Sex Offender: (at hire)
(at hire and annually)
Sex Offender Registry
Florida School Verification (Verify that the School is Licensed)
Texas: Pennsylvania:
TX Verify License PA Verify License
E-Verify: Background Screening
E-Verify (Legal Status) AHCA Background Screening
Driver License check:
FL Drive License Check
TX Background Screening
TX Driver License Check PA Background Check
Live Scan Providers: Live Scan Providers
Florida: Alzheimer's Educator Registration Authorization: Alzheimer's Educator
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.
The 24 hours must include two (2) hours on Prevention of Medical Errors. HIV/AIDS is now a one-time, 1-hour CE requirement to be completed prior to the first renewal. Domestic Violence (DV) CE is now a 2-hour requirement every third renewal. Since Domestic Violence (DV) is a 2-hour requirement, the licensee will have 26 hours of CE during the renewal period when DV is taken. For example, if you renew your license on July 31, 2008 and completed DV during the 2006-2008 licensure cycle, you are required to complete the Domestic Violence CE before the July 31, 2014 renewal.
CPR: must be with life person (not on-line)
All home health aides employed by home health agencies must complete an HIV/AIDS training course. They also are required to obtain and maintain a current certificate in cardiopulmonary resuscitation (CPR). Home health aides employed by Medicare and Medicaid home health agencies are required to have a total of 12 hours of in-service training during each 12-month period (this can be a calendar year or based on the date of hire). The HIV/AIDS training and CPR training may be counted toward meeting the 12 hours of in-service training.
All CNAs must complete a minimum of 12 hours of in-service training each calendar year. Every 2 years, in-service training hours shall include, but are not limited to, the following areas: Bloodborne Pathogens, Infection Control, Domestic Violence, Medical Record Documentation and Legal Aspects Appropriate to Nursing Assistants, Resident Rights, Communication with cognitively impaired clients, CPR skills, Medical Error Prevention and Safety
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