Policy Manual sample

MDT Home Health Care Agency, Inc. · Patient Rights and Responsibilities · Advance Directives · Patient/family liability for payment, if any · Conflict resolution procedure · Type and frequency/duration of care, treatment and/or services to be provided · Patient/family involvement in care, treatment and/or services · If the patient is unable to sign his/her name the Registered Nurse/Therapist shall obtain the patient’s/legal representative’s signature on the form, along with a documented explanation as to the reason the patient is unable to sign his/her name, and the relationship of the representative to the patient. · The Registered Nurse/Therapist shall sign and date the form. · A copy of the signed consent form remains in the patient's home. · The original signed consent form is filed in the patient's office medical record. L-36 Home Health Agency Client Assessments