Page 227 - CHHA Binder 2.3.20

4/11/2019

VNSNY Home Care Consent and Acknowledgement Form

Consent must be given
before Clinician can
continue visit
Must check box for wound photos 15

VNSNY Home Care Consent and

Acknowledgement Form

 The consent form has the question requiring consent for
wound care. The patient can indicate that they either
agree to or decline wound photos. In the event that they
patient can not decided or refuses to sign indicate this on
the side of form. This question is required whether or not
a patient has a wound on admission.
 In the event patient develops a wound and requires
wound photos at a later date the clinician can refer to the
consent form in the home. The clinician can also obtain a
verbal consent form the patient and document this in a
coordination note.
 Clinician must have consent before taking a wound photo.

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