Page 163 - Business Development Orientation Binder

Coordination Note: BD Onsite Assessment

REQUESTED START OF CARE:

HOMECARE REASON/HOMECARE DIAGNOSIS:
TREATMENT ORDERS:

ANTICIPATED DISCHARGE DATE?

ASSESSMENT NOTE FROM BD ONSITE STAFF:

METHOD OF ASSESSMENT (TELEPHONIC OR BEDSIDE):
IS THE PATIENT AGREEABLE TO HOMECARE?

UPDATED VISIT ADDRESS (IF ANY):

IS THE PATIENT RECEIVING ANY OUTPATIENT THERAPY?

(IF YES, PLEASE REVIEW REFERRAL WITH BRANCH AS APPROPRIATE)

ANTICIPATED DISCHARGE DATE?

SPECIAL INITIATIVES/CARE TYPES:

NOTES RELATED TO SPECIAL INITIATIVES:

HOMECARE REASON/HOMECARE DIAGNOSIS:
TREATMENT ORDERS:

CONFIRMED MD COORDINATING CARE IN THE COMMUNITY (FULL NAME):

NEXT APPOINTMENT DATE WITH COMMUNITY MD:

FUNCTIONAL ISSUES:

SPECIFIC TEACHING INITIATED ONSITE: