ࡱ> ` bjbjss ]    8$ 8w"JJJvvvvvvv$Lyh{pv $("v vn!n!n!d8vn!vn!n!l r@r p j.|n<sw08wn$|`$|xr$| rJZ@n!4JJJvv !dJJJ8w           Admission Packet Initials Welcome Page / Hours of OperationAdmission CriteriaRights / Responsibilities of Patient / GrievancesRights of the Elderly HIPPAMedicaid or Medicare Fraud ReportingAbuse, Neglect, Exploitation, Drug Testing PolicyAdvance Directive InformationInfection ControlFamily Disaster PlanHome SafetyPlan and Get ReadyPayment of ServicesPlan of Care SupervisionMedicare Secondary Payer WorksheetMedicare/Medicaid Card VerificationHHABN OASIS Privacy Rights Homebound Statement Consent & Verification of Receipt of Information Emergency Preparedness/ Disaster Plann/aMedication Profile n/aOASIS n/aCommunication Sheet n/aVital Signs Record n/aPatient Calendarn/aDirectionsn/aHHA Care Plan My initials above indicate that I have received the information listed. Signature: _________________________________________ Date: ________ Welcome Letter and Hours of Operation Thank you for choosing YOUR COMPANY NAME HERE for your health care needs. The purpose of this packet is to inform you of your care needs, patient rights and responsibilities, along with valuable information concerning other health care issues. Our mission is to build trusting relationships with patients, families, physicians, and all others devoted to patient care in the home. Working as a team we wish to provide you with quality health care in order to speed your recovery. Together we can help you reach your maximum potential. We work hard to employ and consult with caring and qualified medical personnel. Our job is to provide you with a comprehensive and thorough evaluation of the services you will require and follow that evaluation with treatments tailored to improve your abilities. YOUR COMPANY NAME HERE is located at: STREET ADDRESS CITY STATE ZIP Hours of Operation: 9:00 am to 5:00 pm Monday thru Friday. A member of our nursing staff is available 24 hours / day, 7 days a week. 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