Table of Contents Page ADMINISTRATIVE 1.001.1 Definition of Organization PD1-1A 400.471 408.804 1.001.2 Mission Statement, Goals, and Philosophy PD1-6A PD1-6B 1.002.1 Services Offered PD2-1A 59A-8.008 PD5-4C PD5-4A 1.003.1 Service Area PD5-5B 59A-8.007 1.004.1 Payment for Services 1.004.2 Fee Schedule PD2-1A PD3-6A 1.004.3 Target Population PD5-5B 1.004.4 Service Limitations PD5-5B 1.005.1 Hours of Operation PD2-1A 59A-8.003 1.006.1 Administrative Control PD1-1A PD1-2A PD1-2B PD1-2C PD1-2D PD1-4A PD1-4B PD1-4C PD1-5A PD1-9A PD3-1A PD6-1C 59A-8.003 1.006.2 Ethics Committee PD2-7A 1.006.3 Corporate Compliance Plan 1.006.4 Branch Offices 59A-8.003 1.007.1 Professional Advisory Committee PD1-2A 1.008.1 Annual Evaluation PD1-2A PD1-6A PD1-10B PD3-1B PD4-11B PD5-5B
Page ADMINISTRATIVE Cont. 1.009.1 Admission Criteria PD2-1A PD2-5B PD3-6B 59A-8.020 PD5-3A PD5-3B PD5-4A 1.010.1 Discharge/Transfer from Service PD5-7A 59A-8.020 PD5-7B 1.011.1 Contingency Plan 1.011.2 Agency Closure Procedures 1.012.1 Backup Coverage of Services 1.013.1 Business Associate Contract PD2-5C 1.014.1 Anti Fraud Program PD2-9A 1.016.1 Professional Standards & Principles PD1-7A PD1-7B 1.017.1 Financial Records PD3-1A PD3-2B 1.017.2 Financial Planning PD3-1A 400.471 PD3-1B PD3-4A PD3-5A 1.017.3 Capital Expenditures PD3-1A 1.018.1 Services Provided under Contract PD1-10A PD1-10C PD1-10D 1.019.1 Research Activities/Investigational PD7-10A Studies 1.020.1 Public Disclosure PD1-1A PD2-1A PD3-6A 400.464 1.020.2 Disclosure to Licensing Authority PD1-1B PD1-8A PD1-9A 1.020.3 Change of Ownership/Administrative Control 1.020.4 Plan of Correction 1.021.1 Information Management PD1-1B PD1-4A 59A-8.003 408.811 59A-8.003 59A-8.004 400.476 408.807 Page HUMAN RESOURCES 2.001.1 Reasonable Accommodations 2.002.1 Personnel Records PD4-1A PD4-1B PD4-1C 2.002.2 Employment References PD4-2A
Page HUMAN RESOURCES Cont. 2.002.3 Time Records 2.002.4 OIG Excluded List PD4-2H 2.003.1 Selection of Personnel PD4-2B 2.003.2 Classification of Personnel PD4-2E PD4-2F PD4-2G 2.003.3 Volunteers 2.003.4 Ethics PD2-7A 2.003.5 Employee Dress Code 2.003.6 Employee Health Assessments PD4-2C 2.003.7 Alzheimer's disease or dementiarelated 400.476 disorders Training 2.003.8 Aide Training 400.476 2.004.1 Payday PD4-2I 2.005.1 Benefits & Wages PD4-2I 2.006.1 Confidentiality PD2-5A 2.007.1 Orientation & Staff Development PD1-5B PD1-6A PD1-6B PD2-2B PD2-4A PD2-7A PD2-8A PD2-8B PD3-6A PD4-3A PD4-5A PD4-5B PD7-2A PD7-3B PD7-7a 2.008.1 Policy & Procedure Agreement 2.009.1 Competency Evaluation PD4-6A PD4-6C 2.010.1 Cell Phone and Texting 2.013.1 Performance Evaluation PD4-2I PD4-2J PD4-4A PD4-8A 2.014.1 Employee Discipline 400.476
Page HUMAN RESOURCES Cont. 2.015.1 Termination/Separation of Employment 2.016.1 Employee Grievances PD4-2I 2.017.1 Smoking PD7-5B 2.022.1 Professional Reporting PD1-7B 2.023.1 Drug Testing 2.024.1 Conflict of Interest PD1-3A PD1-3B PD4-2I 2.025.1 Knowledge/Resource Center PD1-7B PD4-7A PD4-13A PD4-14A Page RIGHTS RESPONSIBILITIES ETHICS 3.001.1 Client Conduct Responsibility & Rights PD2-2A PD2-2C PD2-6A PD3-6B PD5-3I 3.001.2 Non Discrimination 3.001.3 Program Accessibility 3.002.1 Solicitation/Distribution for Referrals 3.002.2 Ethical Complaints 3.003.1 Patients Complaints & Grievances PD2-4A PD2-4B 59A-8.0215 3.004.1 Reporting Abuse Neglect or PD2-3A 59A-8.0025 Exploitation 3.005.1 Criminal History Checks PD4-2H 59A-8.004 400.512 408.810 3.005.2 Nurse Aide Registry 3.005.3 National Sex Offender Registry PD4-2H 3.006.1 Out-of-Hospital Do Not Resuscitate Order 59A-8.0245 3.007.1 Advanced Directives PD2-6A 59A-8.0245 3.007.2 Declaration for Mental Health Treatment
Page RIGHTS RESPONSIBILITIES ETHICS Cont. 3.009.1 Coordination of Client Care PD4-10A PD5-3K 3.012.1 Facilitating Communication PD2-8A 3.013.1 After Hours Care PD2-11A PD2-12A PD4-9A 59A-8.003 Page PATIENT INFORMATION 4.001.1 Security of Clinical Information PD2-5A PD5-2A 4.001.2 Data Backups PD5-2A 4.002.1 Retention of Clinical Records PD2-5A PD5-2A 4.003.1 Timeliness of Entries in Clinical PD5-1c Record 4.003.2 Client Records PD5-1A PD5-5C 59A-8.022 400.491 59A-8.022 400.491 59A-8.022 59A-8.022 400.491 4.003.3 Patient Identification 4.004.1 Physician Orders/Plan of Care PD5-3O 4.004.2 Physician Signatures PD5-1C 59A-8.022 4.004.3 Physician Delegation 4.004.4 Physician Verification PD1-11A 4.004.5 RN Delegation 4.005.1 Clinical Record Review/Quarterly Review PD6-2H 4.006.1 Abbreviations 4.007.1 Prohibition on Transporting Patient 4.009.1 Medication Profile PD5-8C 4.009.2 Medication Administration Record PD4-12A PD5-8A PD5-8B 4.009.3 Medication Storage 4.009.4 Emergency Medication 4.009.5 Medication/Prescriptions Orders 4.009.6 Confused Medications 4.009.7 Administration of Blood PD5-8A 4.009.8 Adverse Drug Reactions PD5-8C 4.009.9 Vaccine Storage and Transportation 4.010.1 Medication Reminding 400.488
Page NON-CLINICAL 5.001.1 Billing PD3-2A PD3-2B PD3-3A PD3-7A PD5-5B 5.001.2 Referrals PD2-1A PD5-5A PD5-5B 5.002.1 Verification of Primary Payer 5.004.1 Staffing Issues PD2-8B 400.492 PD5-3Q 5.005.1 Faxing 5.006.1 Protected Health Information Password/Usernames 5.007.1 Red Flag Rules PD2-9A Page CLINICAL 6.001.1 In Service Education PD4-7A PD4-7B 6.002.1 Patient Education PD5-6A PD5-6B 6.004.1 Wound Care Management 6.006.1 Pain Management 6.011.1 Reporting Emergencies in the Home 6.012.1 Cardiopulmonary Resuscitation PD2-6B (CPR) 6.015.1 Clinical Procedures 6.016.1 Care Planning PD2-12A PD5-3A PD5-3F PD5-3I PD5-3K PD5-3N PD5-3O 6.017.1 RN Pronouncement 6.019.1 Assessment of Patients PD5-3A PD5-3C 59A-8.0215
Page CLINICAL Cont. 6.020.1 Nurse Supervision PD4-7D PD4-8B PD4-9A PD4-11C PD4-11D PD4-13E 6.020.2 Registered Nurse PD4-13A 6.020.3 Licensed Practical Nurse PD4-9A PD4-11D PD4-13A 6.021.1 Certified Nursing Aide PD2-11A PD4-9A 400.488 Page SAFETY/INFECTION CONTROL 7.001.1 Infection/Exposure Control Plan PD7-1A PD7-1B PD7-1D PD7-1E 7.001.2 CLIA Waiver PD7-8A 7.002.1 Universal Body Substance PD7-1A Precautions PD7-1D 7.003.1 Management of PD7-1A Infections/Exposures in Personnel PD7-7B 7.004.1 Personal Protective Equipment PD7-1D PD7-6B 7.005.1 Hand washing PD7-1A PD7-1D 7.006.1 Aseptic Technique 7.007.1 Sterile Technique 7.009.1 Respiratory & Tuberculosis Precautions 7.010.1 Tuberculosis Exposure Control PD7-1A Plan
Page SAFETY/INFECTION CONTROL Cont. 7.011.1 Contaminated Reusable Materials Disposition PD7-1A PD7-6A PD7-9A 7.012.1 Contaminated Waste Disposal PD7-1A PD7-6A 7.013.1 Therapy Bag Techniques PD7-9A 7.014.1 Multidrug-Resistant Organisms PD7-1A 7.015.1 Communication of Hazards to Personnel 7.016.1 Hepatitis B Vaccination PD4-2D 7.017.1 Information & Training PD7-1C 7.018.1 Evaluating & Maintaining Records PD7-1E of infections 7.019.1 Reporting of Communicable PD7-1A Diseases 7.020.1 Record Keeping 7.021.1 Medical Equipment Malfunction PD7-9A 7.022.1 Hazardous Waste Handling & Labeling PD7-1A PD7-6A PD7-6B 7.023.1 OSHA Bloodborne Pathogen PD7-1A Training 7.024.1 Incident/Accident Reporting PD6-4A PD7-7A 7.025.1 Agency Personnel Safety PD7-2A Personal Safety 7.026.1 Agency Personnel Safety/ Unsafe PD7-2A Home Visits 7.027.1 Accidental Exposure 7.028.1 Accidental Prevention PD7-2B 7.028.2 Fall Prevention 7.029.1 Car Accident Reporting 7.031.1 Disaster/Emergency Preparedness PD7-2A PD7-3A PD7-3C 7.032.1 Material Safety Data Sheet PD7-2A PD7-6B 7.033.1 Fire Safety PD7-2A PD7-5A PD7-5B 7.034.1 Emergency Power Source PD7-4A PD7-5A 7.035.1 Utilities/Equipment Management PD7-4A 59A-8.027 400.492
Page QUALITY MANAGEMENT 8.001.1 Quality Assessment/Performance Plan PD2-4A PD6-1A PD6-1B PD6-1C PD6-1D PD6-2A PD6-2B PD6-2C PD6-2D PD6-2E PD6-2F PD6-2H PD6-2I PD6-3A PD6-4A PD7-7B PD7-1E 8.002.1 Patient Satisfaction Survey PD6-2G 8.003.1 Non Patient Satisfaction Survey PD6-2G Page PROVISIONS OF INTRAVENOUS THERAPY 9.001.1 Provisions of Intravenous Therapy 9.002.1 Administration of IV Therapy 9.003.1 Nurse Responsibility 9.004.1 Patient Education 9.005.1 Anaphylaxis Protocol 9.006.1 Possession of Supplies 9.007.1 Possession of Dangerous Drugs