As the health care industry’s most comprehensive library of customizable policy and procedure templates, MCN Healthcare’s Home Infusion Therapy Policy and Procedure Manual includes this customizable template, Checklist for Initial Evaluation Form. MCN’s policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more.

Health care organizations around the world utilize MCN’s compliant ready templates and workflow process tools to help them meet the latest changes in regulations and standards.

Here is some sample content from Checklist for Initial Evaluation Form:

	CHECKLIST FOR INITIAL EVALUATION Ask if client has completed an advance directive: If yes, ask for a copy to be provided for the agency's records If no, a pamphlet should be given to the client and explained Client Authorization for Treatment explained and signed: Service agreement Client financial responsibility Agency does direct billing MSP Medicare as secondary payer Bill Rights and Responsibilities was explained: Probable consequence of any care refused How to communicate concerns and/or complaints Admission Procedure was explained and a packet was left with...
Second excerpt:
	...secondary payer Bill Rights and Responsibilities was explained: Probable consequence of any care refused How to communicate concerns and/or complaints Admission Procedure was explained and a packet was left with client/caregiver: Scope of service Business hours Phone numbers to call and people who can be called upon for assistance After hours procedure The guidelines for home safety were left with client/caregiver: Emergency phone numbers Natural disaster plan Signature of Nurse:...