{"ref":"CA-HH-CC-01","title":"Coordination of Services, Significant Change Notification, and Case Conferences","category":"Service delivery","summary":"Sets the Agency’s policies stating when notification is required for a significant change in a patient’s condition (22 CCR §74697(d)), who notifies the attending practitioner and the team and how fast, and how notifications are recorded (§74697(e)); how the Director of Patient Care Services and the registered nurse coordinate all services (§§74703(a), 74707(a)(4)); how therapists, social workers, and dietitians report (§§74711(b)(4), 74713(c)(3), 74715(b)(3)); case conferences, including contracted staff (§74719(b)(3)(D)); and, if the Agency is Medicare-certified, prompt alerts to the practitioner and coordination of care (42 CFR §484.60(c)-(d)).","inShort":["In an emergency, call 911 first, then the nurse supervisor.","Report any fall, new pain, breathing trouble, confusion, infection, medication problem, or hospital visit to the nurse supervisor right away by phone.","Aides: call your supervising nurse or therapist about any change. A text or voicemail alone is not enough.","Nurses: tell the doctor within the times in Table 1 and record who you told, when, and what they said.","Read the other disciplines’ latest notes before each visit, and take part in case conferences."],"primaryCitation":"22 CCR §74697(d)","citations":["22 CCR §74697(d)","22 CCR §74697(e)","22 CCR §74707(a)(3)","22 CCR §74707(a)(4)","22 CCR §74703(a)","22 CCR §74711(b)(4)","22 CCR §74713(c)(3)","22 CCR §74715(b)(3)","22 CCR §74719(b)(3)(D)","22 CCR §74710(a)(9)","22 CCR §74607(b)","22 CCR §74709(a)(4)"],"federalCitations":["42 CFR §484.60(c)","42 CFR §484.60(d)"],"surveyorAsks":["Show me your policy on when staff must notify the physician of a significant change.","This patient fell last month. Show me when the physician was told and how it is recorded."],"forms":[{"ref":"CA-HH-CC-01-A","title":"Significant Change Notification Record"},{"ref":"CA-HH-CC-01-B","title":"Case Conference Record"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (22 CCR §74697(d))","5. When Notification Is Required","6. How to Notify and Record","7. Coordinating Services","8. Contracted Staff and Other Providers","9. Case Conferences","10. Responsibilities","11. Records and Compliance Monitoring","12. Staff Training","13. References","14. Related Policies and Forms","15. Approval","16. Revision History"],"version":"1.0","sample":false,"pack":"ca-hha","state":"California","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}