Page 165 - Business Development Orientation Binder

Intake Patient Interview Guide—PANEL 1 Intake Patient Interview Guide—PANEL 2
Visiting Nurse Service of New York

Overview: This interview guide is developed to assist in determining what to ask during a patient interview. Questions/statements are not intended to be repeated verbatim—please
use your own words when speaking with patients. Italics = general statements and direction; Regular type = question suggestions

Introductions / Setting the Stage / What Homecare is All About Patient Personal Info Follow order of MDS when asking questions
 Introduce self, title, VNSNY, who sent you and why  I need to ask you questions to verify your contact information. Would you please
 Is this a good time for us to talk? spell your name for me?
 If family/guests in room: would you like me to come back later when your visitors are  What is the address you will be going to after discharge from hospital?
not here?  Is this your permanent address?
 Social Worker/Case Manager informed me that the Doctor has requested home  Please tell me your phone number?
care services for you when you are discharged from hospital  Do you have a cell phone?
 Do you have any past experience with homecare?—if recent, ask for name of  Who is your care giver and phone number?
homecare provider. If unable to determine f/u with hospital SW  Who is your emergency contact person and their phone number? (ensure that # is
 Explain what homecare can do including teaching, helping to manage meds, different from the pts other phone numbers)
procedures, treatments, evaluating how you are responding to tx  Do you have an email address?
 Explain the reason homecare was requested for this person
 Explain what we could do for them at home Living / Social Situation Note: if patient independent in ADLs, may not need to
ask…
Confirm Acceptance of Homecare  Who do you live with anyone? What is their name and phone number?
 Would it be OK for a nurse to come visit you in the home?  Is there anyone available to help you at home?
 Remind that MD ordered homecare for them  When are they available? Do you have a neighbor who can help with shopping or
 If hesitant, explain that it is not mandatory to have homecare but that you suggest to errands?
try homecare. Can always change mind later  Do you have any pets? Who will be taking care of them when you get home?
 Can you tell me what kind of an apartment you have—how far is the bathroom from
Payment Information the bedroom? Do you have an elevator in your building? If no, how many flights up
 For pts with managed care: You have XXX insurance are you?
 We are going to submit a request to your insurance company for authorization  What would you do if you had to get out of the house in an emergency? (ensure that
to begin services. Sometimes it takes up to 72 hrs for the insurance company to emergency exit plan is appropriate—contact your manager with questions)
make a determination. As soon as we get that authorization we will inform you
of the amount of service your insurer has pre-authorized and discuss with you Community MD
how that authorization will impact the service we will provide for you. This may  Who is your community physician, the doctor you see when you are at home? What
cause a delay in your start of service but we will actively f/u with your insurer to is the doctor’s name & contact information?
help achieve a timely start of homecare & keep you in the loop  Have you made an appointment to see your doctor when you are d/c? It’s very
 After confirming insurance if patient has a co-pay per visit, notify patient. important that you make an appt to be seen by the doctor within 7 days of
 If pt states payment is a problem consider asking: how will you manage if you discharge. You may feel much better but it is very important to have your physician
do not have any help at home? f/u on your treatment progress.
 For Medicare and or Medicaid patients: homecare services are paid for with no  Can you tell me what your plan is to make your doctor’s appointment?
co-pay requirement  If pt does not have a community MD ask: Do you go to a clinic? If yes, which clinic?

Copyright 2009 VNSNY—Unauthorized Use Prohibited Version 02-24-14