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Coordination of Services and Communication with Other Providers

Sets out how the Agency coordinates the services it gives with its own staff and with the client's other providers: how the division of services is agreed and recorded when another provider also serves the client, how the client is told what the Agency will do to coordinate, how aides, nurses and office staff share information, how the Agency communicates with physicians and other health care professionals with the client's consent, when case conferences are held and minuted, what happens when a client goes into and comes home from a hospital, and how teaching given to the client and family caregivers is recorded.

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About this policy
Policy number
DC-HC-SP-02
Version
1.0
Main rule
22-B DCMR §9919
Library
Washington, DC home care · 50 policies
Category
Service delivery
Sections
20

In short

  • Many clients also see a nurse, therapist or hospice. The service plan says who does what. Follow only the Agency's plan.
  • If another provider's staff ask you to do something different, say politely that you follow the Agency's plan, and call the registered nurse.
  • Read the last visit notes before you start, and write clear notes for the next aide.
  • Only the registered nurse talks with the client's doctor and other providers, and only with the client's consent.
  • Share client information only by Agency phone, secure messaging or the Agency record, never on personal social media or group chats.

What's inside

20 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 (22-B DCMR §9919)
  • 5. Who the Agency Coordinates With
  • 6. Delineation of Services
  • 7. Telling the Client What the Agency Will Do
  • 8. Communication Within the Agency
  • 9. Communication with Health Care Professionals
  • 10. Case Conferences
  • 11. Hospital Stays and Returning Home
  • 12. Teaching the Client and Caregivers
  • 13. Responsibilities
  • 14. Records and Compliance Monitoring
  • 15. Staff Training
  • 16. References
  • 17. Related Policies and Forms
  • 18. Approval
  • 19. Revision History

An inspector may ask

  • This client also has a home care agency nurse. Show me where you recorded who does what.
  • How did you tell this client what your Agency will and will not do to coordinate services?

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