HHA/PCA Monthly CallCDPAP Monthly CallHHA/PCA Monthly Call Case Coordinator's Name : (required 必填)Patient's First Name : (required 必填)Patient's Last Name : (required 必填)Patient's Date of Birth: (required 必填)Aide's Name : (required 必填)Aide Code: (required 必填)I. Does the Personal Assistant adhere to Agency's Policies & Procedures? (1) Attendance/Punctuality (2) Appearance - Always well-groomed with appropriate attire (3) Maintains patient's safety and confidentiality (4) Using EVV to confirm visits and enter duties (5) Appropriately fill out timesheets if necessarySatisfactoryNeeds ImprovementII. Approach to work (1) Positive Attitude (2) Accept constructive criticism (3) Flexible and adaptableSatisfactoryNeeds ImprovementIII. Compliance with the Plan of Care (1) Fulfill responsibilities/duties listed on Plan of Care by visiting nurseSatisfactoryNeeds ImprovementIV.Appropriateness, adequacy, and effectiveness of service (1) Has good working relationship with patients/clients (2) Carries out job skills proficiently (3) Communicating effectively with all those involved in providing careSatisfactoryNeeds ImprovementV.Evaluations of anticipated patient outcomes (1) Anticipate Patient OutcomesSatisfactoryNeeds ImprovementAdditional Notes :Authorized Representative's Signature / 簽名: (required 必填) CDPAP Monthly Call Case Coordinator's Name : (required 必填)Patient's First Name : (required 必填)Patient's Last Name : (required 必填)Patient's Date of Birth : (required 必填)Aide's Name : (required 必填)Aide Code : (required 必填)I. Does the Personal Assistant adhere to Agency's Policies & Procedures? (1) Attendance/Punctuality (2) Maintains patient's safety & confidentiality (3) Using EVV to confirm visits and to enter duties (4) Appropriately fill out timesheets if necessaryYes / 有No / 沒有II. Plan of Care Implementation (1) Consumer able to direct PA to fulfill responsibility/dutiesYes / 有No / 沒有III. Appropriateness, adequacy, and effectiveness of services offered (1) Has good working relationship with patients/clients (2) Carries out job skills proficiently (3) Communicates effectively with all those involved in providing careYes / 有No / 沒有Additional Notes :Authorized Representative's Signature / 簽名: (required 必填)
