Coordination of Services, Case Conferences, and Communication with Authorized Healthcare Providers

Sets out how the Agency coordinates the care given by every discipline, employed or under contract, with the patient, caregivers and authorized healthcare providers from admission through discharge: who coordinates, how changes in the patient's condition are reported to the authorized healthcare provider and the supervising RN, case conferences and their records, written instructions given to the patient and caregiver, and ongoing education and training.

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About this policy

Policy number: LA-HH-CC-01
Version: 1.0
Main rule: LAC 48:I §9123.F
Library: Louisiana home health · 57 policies
Category: Service delivery
Sections: 19

In short

Every patient has a case manager who coordinates all disciplines.
Report any change in condition to the supervising RN; urgent changes before you leave the home.
Aides call the RN about abnormal vital signs.
Record every call with the provider: who, what you reported and the answer.
Take part in case conferences; they are recorded in the patient's record.
Keep the written visit schedule and medication instructions in the home up to date.

What's inside

19 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 (LAC 48:I §9123.F)
5. Who Coordinates
6. Reporting Changes in Condition
7. Communication with Authorized Healthcare Providers
8. Case Conferences
9. Coordination with Contract Staff and Other Providers
10. Written Instructions for the Patient and Caregiver
11. Patient and Caregiver Education and Training
12. Responsibilities
13. Records and Compliance Monitoring
14. Staff Training
15. References
16. Related Policies and Forms
17. Approval
18. Revision History

An inspector may ask

How do the nurse, therapist and aide caring for this patient communicate with one another?
Show me the last case conference for this patient. Who took part?

Louisiana home health

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Rules it follows

LAC 48:I §9123.FLAC 48:I §9123.F.2LAC 48:I §9127.CLAC 48:I §9103.B.2.bLAC 48:I §9103.D.2.bLAC 48:I §9103.F.2.cLAC 48:I §9103.F.2.hLAC 48:I §9103.G.2.cLAC 48:I §9103.G.2.gLAC 48:I §9103.I.2.cLAC 48:I §9103.I.2.hLAC 48:I §9103.K.2.fLAC 48:I §9103.K.2.gLAC 48:I §9103.L.2.cLAC 48:I §9103.C.2.aLAC 48:I §9123.E.342 CFR §484.60(d)42 CFR §484.60(e)42 CFR §484.60(c)(3)42 CFR §484.105(c)

Forms included

LA-HH-CC-01-A Case Conference and Care Coordination Record

Read a sample in full

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