Agency policy on Discharge and Transfer Provided in a language and manner the patient or representative understands in advance of providing direct care or education. X OASIS Comprehensive Assessment Complete assessment of the patient at the time of the visit and prior 24 hours. X ** Medication Profile/List Medication schedule/instructions including, medication name, dosage and frequency and which medications will be administered by Agency personnel and personnel acting on behalf of the Agency. The information must be written in plain language avoiding the use of medical abbreviations. X X Safety Handout/Assessment Note patient specific concerns, education. Must include hazardous waste disposal if applicable. X Patient/Client Individual Emergency Plan/Emergency Preparedness Individualize to the patient/client. Note in OASIS SOC assessment the plan/triage code. X Contact information to include name, address, and telephone number for: Agency Administrator, Agency Clinical Manager, Agency on Aging, Center for Independent Living, Protection and Advocacy Agency, Aging and Disability Resource Center, and Quality Improvement Organization X *Document to provide patient/client with treatments and any other pertinent instructions Any treatments to be administered by Agency personnel and personnel acting on behalf of the Agency, including therapy services. Any other pertinent instructions related to the patient/client’s care and treatments that the Agency will provide, specific to the patient’s care needs X *Visit frequency calendar A calendar or another method to provide the patient/client with their visit schedule, including frequency of visits by Agency personnel and personnel acting on behalf of the Agency X Home Health Aide Care Plan (if aide services are ordered) X X Vital Signs Log (optional) X
