Policy Manual sample

MDT Home Health Care Agency, Inc. more often if necessary based on patient needs and clinical status to evaluate the appropriateness of the plan and the patient’s progress toward goals.  The authorized healthcare team member updates the plan of care as necessary, after the physician was notified of the need to alter the plan of care and was approved.  The plan of care is dated and signed by the appropriate discipline whenever it is reviewed, event if there are no changes to the plan of care.  A copy of the modified plan of care is distributed to all members of the healthcare team providing care and/or services to the patient.  Verbal care conferences conducted on an impromptu, as-needed basis should be documented in the visit notes or each of the disciplines involved.  Multi-disciplinary care conference are held on selected patients at least monthly and more frequently if needed to promote coordination and continuity of care. The results documented and a copy is retained in the patient’s medical record.  All disciplines involved in the patient’s care, including contracted services, are encouraged to attend the monthly conferences. Home Health Agency Nursing Manual J-56