Responsibility, Skill, or Procedure

Yes

No

Provides input relative to the psychosocial component of illness and assists home care team, patient, and physician in development of the plan of care.

Responds within 5 days of referral and completes psychosocial assessment, unless alternative plans are requested by patient/caregiver

Evaluates patient’s caregiving plan including assessment of the home environment and primary caregiver status

Evaluates social support network of family members and other caregivers

Financial assessment including resource constraints of patient, family and caregiver

Discharge plans, needs and arrangements

Emotional coping abilities of the patient, family and/or caregiver

Significant risk factors affecting the patient, family and/or caregiver

Ongoing assessment of the patient’s/family’s needs and concerns

Develops realistic goals based on observations, actions and plans

Resource coordination

Discharge planning

Individual and family counseling

Resource coordination

Discharge plans and after-care

Safety guidelines

Psychosocial assessment

Progress/Visit Notes reflecting visits, phone calls and referrals

Discharge/Transfer Record

Plan of Care development and changes (HCFA 485)

Observations & Clinical Changes

Obtaining verbal orders

Access to other resources through referral to government or community programs relative to client’s needs

Access to other resources through referral to other team members

Nurse

Physical Therapist

Speech-Language Pathologist

Occupational Therapist

Home Health Aide

Other: (identify):

Performs teaching to client/family

Maintains client confidentiality/HIPAA

Conducts self in a professional manner

Reports to supervisor as needed and appropriate

Maintains Infection Control Guidelines for Hand washing, etc

Participates in interdisciplinary/case/team conferences as needed