Home Care Admission Packet

The Home Care Admission Packet includes a 2-pocket folder, Guide to Health at Home Booklet, and eight forms shrink-wrapped in order of use.

The Admissions Folder provides staff contact information and statement of confidentiality. Designed to provide a central location for the client to keep their home care information close at hand. Customize the folder with your agency logo and/or information. (Briggs custom label H11908L)

Your Guide to Health at Home Booklet contains all the necessary and regulatory information for a new home care client and their family. This guide has been developed with the client in mind using large fonts and simplified language. Staff information and Medicare requirements are covered. The guide also includes such topics as patient rights, confidentiality, safety, infection control and emergency preparedness. The inclusive booklet was designed for ease of use by the nurse and client, click to view it here.

Forms include:

Admission Service Agreement

Medicare Secondary Payer Worksheet

Statement Patient Privacy

Do Not Resuscitate Request

Medication Profile

Medication Profile Addendum

Medication Side Effects

HHA Care Plan

Home Care Visit Calendar

Individualized Emergency Plan

Home Care Aide Care Plan