Prescribed Visits Calender Worksheet

This form serves as an internal worksheet to compare, by discipline, the actual visits providedwith the prescribed visit frequency and duration. In other words, this form provides a mechanism to evaluate compliance with ordered frequency and duration as well as adequacy of order for disciplines, and to identify additional and/or missed visits.

May also be used to incorporate into quality improvement processes for compliance and reimbursement, track aide supervision visit frequency, use as an in-service tool for training relating to plan of care, care coordination and physician orders.

Note: Is similar in design to the surveyor/site visitor calendar utilized in a CMS medicare home health certification survey.