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
Administrator/DON: Survey Ready Check List
(The template must be updated with your discussion and Agency's reality data)
INFECTION PREVENTION:
ADD to Infection Control LOG, also discuss in BD meetings:
DON, Clinical Manager-QA Prioritized Infection Risk Report (Monthly)
Prioritized Infection Risk Surveillance of Infections Report
Infection Control Log Prevention/Tx Log: Infection Prevention/Tx
DON: Infection Control Risk Assessment Infection Prev. Risk Assessment (Quarterly)
DON-QA Infection Control program effectiveness Report (Quarterly)
Infection Control Effectiveness
Miami Dade EPI Report: Infection EPI Report Request copy to: Vanessa.Villamil@flhealth.gov
DON, Clinical Manger-QA Hand Hygiene Improvement Intervention (to be posted in the Agency's Information Board) (Quarterly)
Hand Hygiene Patient Survey Hand Hygiene Pt Survey Summary
FALL PREVENTION: 
Add to Fall Prevention LOG, and BD meeting:
DON-QA Fall Prevention Intervention Plan (Monthly)
Fall Prevention Intervention Plan Monthly Fall Tracking
DON, Clinical Manager-QA Fall Prevention Program (Intervention Analyzes Report) (Quarterly)
Fall Prevention leadership Intervention Agency Fall Prevention Evaluation
DON, Clinical Manager-QA
Fall Prevention Assessment (Quarterly) Fall Investigation Report(Quarterly)
Agency Fall Prevention Assessment Fall Investigation Report
DON, Clinical Manger-QA Fall Prevention Data Collection (Monthly)
Fall Prevention Data Collection
DON, Clinical Manager: Fall Prevention (Prioritized List) LOG (Must be completed monthly)
QAPI REPORTS:
QA/DON/Clinical Manger: Monthly report about hospitalization, emergency care prevention (results of risk assessment)
(QAPI PROJECT)
DON: Hospitalization LOG (Must be completed monthly) Hospitalization Log
Hospitalization risk analysis: Hospitalization risk analysis Emergency care risk analysis: Emergency Care risk analysis
QAPI Project Hospitalization/Emergency Care: Hospitalization/Emergency care services risk Project
QAPI Plan-Do-Study-Act (PDSA) Hospitalization/Emergency Care PDSA
Decreasing Hospitalization, Improvement report: Decreasing hospitalization/Improvement Report
Cardio Vascular Disease Project: CVD Project CVD Plan-Do_Study (PDSA) CVD PDSA
(Complete the DC Planning control log, and have the Total DC patients with High BP)
DON, Clinical Manager/QA: Performance Levels, Patterns, Trends, Variations: (Quarterly)
PI: Performance, Patterns, Trends
DON, Clinical Manager: OBQI Analyzes LOG (OBQI report must be analyzed by the Agency on Regular BD meeting, this log documented the review of the OBQI (Casper) reports) (Quarterly)
OBQI Analyzes Log Adverse Event (OBQI Analyzes)
MEDICATION MANAGEMENT:
DON, Clinical Manager: Medical Error Management Analyzes
Medical Error Management Analyzes Quarterly Medical Error Incident Report Complete report as needed
Total Medical Error Incidents (%) (Monthly)
Medication Management Analyzes Quarterly BEERS Criteria Medication List
DON: Patient on OXYGEN therapy LOG (Must be completed quarterly) Patients on Oxygen Log
MULTIPLE REPORTS:
DON: Coordination of Care Compliance/Tracking LOG (Quarterly) Coordination of Care
Administrator/DON: Complaints Log (Monthly)
Complaints Log Summary Complaints Log (detail) Summary
Administrator/DON/QA: Total of Incidents Summary/Occurrence Report (Monthly)
DON, Clinical Manager: Home Health Value Based Purchased report to CMS (Quarterly)
DON, Clinical Manager: Total Monthly Discharge Patients by reasons Report Must be completed (Monthly)
Total Discharge Patients Discharge Planning Log
DON, Clinical Manager-Administrator Following Policy Log (Quarterly), Compliance Report (Quarterly)
Following Policy Log Compliance Report
Safety Tracking LOG (All year long) Safety Tracking Log (Complete all reports in Safety Minutes)
DON, Clinical Manager: Diabetes/Insulin Administration (PI Data Control List) LOG Must be completed (Quarterly)
Add to QAPI meeting (Quarterly)
DON, Clinical Manager/Administrator: INCIDENT Occurrence Report Must be completed (Monthly)
Administrator Financial and Billing Report to BD (Quarterly) Financial/Billing Reports
DON, Clinical Manager: More Common Diseases report by counties: (Monthly)
Florida:
Miami Dade Monroe County (Keys) Broward
Palm Beach Duval County Indian River
Seminole County Orange County Brevard County
Osceola County Hardee County Highlands County
Hillsborough County Manatee County Polk County
Charlotte County Collier County DeSoto County
Glades County Hendry County Lee County
Sarasota County Pasco County Pinellas County
California:
Illinois:
Pennsylvania:
Texas:
Fort Bend County TX Harris County TX
CMS Medicare Balance Report: Due on 1 - 30 of January, April, July and October (Quarterly)
Medicare Balance Report You can fax the report to: (803) 419-3277
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.
Copyright 2024 PN System. All Rights Reserved.
