Clinical Record Review Summary Report

1. Patient Consent for Care and Referral/Intake/Face-to-Face

a. Issue

b. Correction Plan

2. Initial and Comprehensive Assessment

a. Issue

b. Correction Plan

3. Plan of Care

a. The first issue noted:

i. Issue:

ii. Correction Plan:

b. The second issue noted:

i. Issue:

ii. Correction Plan:

4. Orders and 485

a. Issue

b. Correction Plan

5. Medication Management

a. Issue

b. Correction Plan

6. Care Coordination and Documentation

a. Issue

b. Correction Plan

7. Skilled Nursing

a. Issue

b. Plan of Correction

8. Social Work

a. Issue

b. Plan of Correction

9. Physical Therapy Services

a. Issue

b. Plan of Correction

10. Occupational Therapy Services

a. Issue

b. Plan of Correction

11. Home Health Aide

a. Issue

b. Plan of Correction

12. Discharges/Transfer and Summaries

a. Issue

b. Plan of Correction

Respectfully Submitted,

Director of Nursing/Clinical Manager

Administrator Comments Follow-up, Signature and Review:

Ideal HomeHealth Care, LLC

1. Patient Consent for Care and Referral/Intake/Face-to-Face

2. Initial and Comprehensive Assessment

3. Plan of Care

4. Orders and 485

5. Medication Management

6. Care Coordination and Documentation

7. Skilled Nursing

8. Social Work

9. Physical Therapy Services

10. Occupational Therapy Services

11. Home Health Aide

12. Discharges/Transfer and Summaries