Aide Supervisory Visit/Telehealth
UPDATED FEBRUARY 2022
This one-page form allows the appropriate skilled professional to document that the aide is furnishing care in a safe and effective manner.
If during the telehealth visit the skilled professional identifies an area of concern the form provides a place to document the situation and the date of a scheduled on-site visit if needed. The clinician may also document changes in the patient’s condition or care needs and the appropriate follow-up.
This form includes:
•The time the call was started and ended
•The type of device used to complete the call
•The call participants
•The aide’s presence or absence
•The reason for the virtual visit
•Pertinent follow-up interventions effecting the plan of care
•Documentation of communication with the physician, if applicable
Print: 1-side, black ink
Punching: 5-holes top and side
Packaging: 100 per pad