HIGH PEAKS HOSPICE & PALLIATIVE CARE, INC.
CLINICAL POLICIES AND PROCEDURES
As of May 23, 2017
These policies are listed in alphabetical order regardless of policy number; revision date is indicated after the title. Forms are listed under the policy to which they pertain.
Form - Intake Worksheet R08/14
Advance Directives CP-204 (Rev 03/21/17) (Also See "Do Not Resuscitate, CP221")
Brochure: Planning Your Health Care in Advance (NYSOAG)2016 (27 Pages)
Information: Patient Self-Determination Information (Rev 01/17)
Adverse Events CP230 (Rev 05/25/16) replaces "Incident Reporting"
Form - Guidelines for ALS (Rev 10/15)
Form - Guidelines for Cancer (Rev 10/15)
Form - Authorization for Release of Health Information and Confidential HIV Related Information (DOH2557, R2/11) go to NYS DOH Website for this form
Form - Redisclosure of HIV Information (Upd 10/15)
Form -Hospice Aide Activity Sheet (Rev 12/16)
Form -Hospice Aide Extended Service Checklist (Rev 12/16)
Form - Hospice Aide Orientation/Supervision Summary (Rev 12/16)
Form - Hospice Aide Orientation to Hospice Care (Rev 12/16)
Initial and Comprehensive Assessment of Patient CP233 (Rev 03/21/177) Was "Initial Assessment and Admission Note" (Upd 07/01/2008)
Form - IDT Sign-in Sheet (Rev01/15)
Movement of Patients Between Sites within HPHPC CP-269 (Rev 05/25/16) replaced "Transfer of Patients Between Sites within HPHPC
Form: On Call Log (Rev 08/16)
Instructions: ABN of Non Coverage CMS-R-131
Information - Informed Consent Policy by Arent Fox
Scope of Service – Bereavement CP-260 (Rev 03/26/14)
Form - Bereavement Follow-Up Adult (Upd 02/12)
Form - Bereavement Follow-Up Child (Upd 02/12)
Form - Bereavement Referral Form - Adult (Upd 02/12)
Form - Bereavement Referral Form - Child (Upd 02/12)
Scope of Service - Spiritual Care CP263 (Rev 03/21/17) was "Scope of Service - Pastoral Care"
Suspected Abuse and/or Neglect CP-266 (Upd 07/01/2008)
Form - Report of Suspected Child Abuse (NYS OCFSForm 09/16) Fill in form on NYS OCFS website