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Client Records, Retention, and Access

Sets what every client record contains under each license route, how long records are kept (three years after services end for the service provision plan of a licensed agency, five years after services for Medicaid records, the longer of the two where both apply), how records are stored and produced for unannounced surveys, how electronic and faxed signatures are handled, how clients inspect and obtain copies of their records, and what happens to records on a change of ownership, a closing, or disposal.

Preview: full text with a package
About this policy
Policy number
FL-HC-RM-01
Version
1.0
Main rule
s. 400.491(2), F.S.
Library
Florida home care · 50 policies
Category
Records
Sections
18

In short

  • Every client has one confidential record. File each signed paper with the office the day you get it.
  • Keep the home folder private and current. It holds the task plan, emergency contacts and the client emergency plan.
  • Never take records home, leave them in your car overnight, or throw them in the trash.
  • If a client or family member asks for a copy of the record, give them the request form and tell the office.
  • We keep client records at least 3 years after services end, and 5 years for Medicaid clients.

What's inside

18 sections. The full text comes with the One-time Policy Pack.

Full text with a package
  • Terms of Reference
  • 1. Purpose
  • 2. Scope
  • 3. Definitions
  • 4. Policy Statement (s. 400.491(2), F.S.)
  • 5. What the Client Record Contains
  • 6. How Long Records Are Kept
  • 7. Storage, Security, and Production for Surveys
  • 8. Electronic and Faxed Signatures
  • 9. Client Access to Records and Copies
  • 10. Change of Ownership, Closing, and Disposal
  • 11. Responsibilities
  • 12. Records and Compliance Monitoring
  • 13. Staff Training
  • 14. References
  • 15. Related Policies and Forms
  • 16. Approval
  • 17. Revision History

An inspector may ask

  • Show me the record for this client. Where is the signed written agreement that serves as the service provision plan?
  • How long do you keep a client record after services end, and how long do you keep records of Medicaid clients?

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