MCN’s customizable template, List of Client Charges Form, is taken from our Home Infusion Therapy Policy and Procedure Manual. MCN Healthcare’s proven policy and procedure templates, competencies and compliance tools have assisted more than 20,000 health care organizations worldwide meet their regulatory compliance goals.

MCN’s templates save you time, money and resources, rather than developing healthcare policy and procedure manuals from scratch.

Here is some sample content from List of Client Charges Form:

	LIST OF CLIENT CHARGES Case #: Client Phone #: q IV Access Access Device Supplies Item # Qty Admin. Device Supplies Item # Qty Routine Supplies Item # Qty SUB-Q LINE SUPPLIES: INJECTION CAPS: FLUSH-VIALS: Sub Z Set 27 g x 107 cm Safesite/Reflux Interlink Ndl Cannula Tegaderm 2 x 3 Red Caps Vial Access Cannula 2 x 2 Gauze Interlink Site NS 10 mL PERIPHERAL IV SUPPLIES: Third Cannula NS 20 mL Hepik Kit w/ Interlink Lever Cannula 10 units Heparin 10 mL Tourniquet GRAVITY MINIBAGS/MASTERFLOW: 100 units Heparin 10 mL Extension Set IV Pole 100 units per mL Heparin 30 mL Tegaderm 2 x 3 IV Set...
Second excerpt:
	...2 Gauze Masterflow use 22g IV Cath & 20g Nd 3 mL Syr - Luer Tube Gauze 0.2 Filter 6 mL Syr - Luer IV CATHETERS: 1.2 Filter 12 mL Syr - Luer Insyte HOME PUMP BALLS 20 mL Syr - Luer HPB Bag MISCELLANEOUS: Strmline BARD MINI INFUSER Alcohol Swabs 60 Ext. Set Betadine Swabs SABRATEK PUMP Skin Preps EZ Set IV Pole Tape Durapore Baxter IV Admin. Set Jelco McGaw Tbg Tape Transpore 0.2 Filter PIC/CENTRAL/PORT SUPPLIES: 1.2 Filter Tape Foam Central Line Kit - Adult SAB Manual Sterile Gloves Pump Type...