Home Care Visit Calendar and Patient Centered Care Plan

Briggs Home Care Visit Calendar and Patient Centered Care Plan offers a solution to meeting the plan of care’s five components that must be written, easily understood and provided to the patient, caregiver and/or the patient’s representative, at the start of care. [§484.60(e); G570]

•Visit schedule with frequency and personnel acting on behalf of the HHA

•Medication list with instructions (must be provided separately)

•Treatments administered by personnel acting on behalf of the HHA

•Any other pertinent instruction related to the patient’s care

•Name and contact information of the HHA clinical manager

The calendar identifies the day of the week and date is filled in as needed to coincide with the start of care. The large boxes provide ample room for each clinician and/or personnel to write their visit schedule, including the time and frequency of visits and the service they will provided.

The Patient Centered Care Plan provides a place to record the patient’s goal(s), treatments, special instructions and the clinical manager’s phone number. The medication list will need to be provided separately.

The form instructions for use are included to promote consistency between the agency personnel. The calendar and Patient Centered Care Plan are on separate sheets so each one can be updated independently, as needed. The form is completed by hand, so it can be written in any language using words that are understandable to the patient, caregiver and/or representative.

Download a sample today!