Aide Supervisory Visit/Telehealth -DIGITAL FORM

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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

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*This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment). After 1- year, your update subscription will automatically renew.