1. Patient has a skilled need - medically directed care under the direction of nurse or licensed clinician
    
2. Must be home bound 
   • Taxing effort to leave home because of illness or injury
   • Medically contraindicated due to a specific condition
   • Absences from home infrequent and of short duration

Must have a qualifying face to face encounter 90 days prior to Start of Care or 30 days after.

1. Primary Diagnosis must be specific. 
2. Must be the underlying cause of patients symptoms (not the symptom itself).
3. If the diagnosis has a location (ie: wound, fracture, etc)
   • Must specify left or right
   • Dominant or non dominant side

• Weakness
• Debility
• Abnormal gait
• Dizziness
• Fatigue
• Pain
• Syncope

• Medicare required Physician or other licensed Practitioner in person visit.
  • must be 90 days before or 30 days after Home Care Start of Care
• Encounter must be related to reason for the referral to Home Care.
• Information for Face to Face may be used from:
  • Office Visit Note
  • Progress Note
  • Emergency Room Note
  • Facility Note
  • Any Discharge Summaries
  • Operative Note

• Certify that Home Care services are medically and reasonably necessary
• Be an active participant in the patient's plan of care
• Provide legible, complete, and accurate information, including treatment orders for his/her patient
• Notify CVNA when there is a change in patient's care that we may need to be aware of
• Review, sign, and date all physician's orders, including Interim orders within 30 days from date of order. Make corrections as necessary
• Be available to Home Care Staff in order to provide the appropriate and necessary care of the patient, including coverage should you not be available
• Keep all communication between physician, home care staff, patient and family confidential

• Hospice can be appropriate for patients with either a cancer or non cancer diagnosis
• Has a prognosis of 6 months or less if disease follows typical trajectory
• End Stage Disease
  • Pulmonary
  • Renal
  • Cardiac
  • Others
• Stroke or Coma
• Cancer Diagnosis

• Be an active participant in the development of the plan of care and the comprehensive interdisciplinary group plan of care in the provision of hospice orders.
• Provide hospice with timely information regarding his/her patient including changes in patient condition or response to care
• Be available to respond to questions regarding patients.  When the attending physician is not available, another physician will be designated as the alternate coverage
• Provide legible, complete, and accurate information, including treatment orders for his/her patient.
• Sign and return Certification of Terminal Illness within 48 hours of start of care.
• Sign and return hospice orders within 30 days of date of order.
• Participate in the consideration and resolution of ethical issues related to hospice patients
• Maintain confidentiality of all communication between the physician, the hospice staff, and the patient and family