DMEPOS Operational Policy and Procedure Manual

Table of Contents 

Chapter 1 

Policy 1-01 - Patient Rights 

Attachment 1-01-01 - Patient Bill of Rights 

Attachment 1-01-02 - Customer Orientation Form 

Policy 1-02 - Staff Comprehension of Rights and Responsibilities 

Policy 1-03 - Patient Participation and Consent for Services 

Attachment 1-03-01 - Organization Objectives 

Attachment 1-03-02 - Equipment and Services 

Policy 1-04 - Refusal of Care and Service 

Attachment 1-04-01 - Release of Liability 

Attachment 1-04-02 - Visit Refusal Report 

Policy 1-05 - Resolution of Conflicts 

Policy 1-06 - Ethical Guidelines 

Attachment 1-06-01 - Code of Ethics 

Policy 1-07 - Conflicts of Interest 

Attachment 1-07-01 - Conflict of Interest Notification 

Policy 1-08 - Resolution of Ethical Issues 

Attachment 1-08-01 - Ethical Resolution Checklist 

Policy 1-09 - Patient Complaints and Compliments 

Attachment 1-09-01 - Patient Communication Form 

Policy 1-10 - Confidentiality, Communication, and Informed Consent 

Attachment 1-10-01 - Employee Confidentiality Agreement 

Attachment 1-10-02 - Authorization for Release of Information, Assignment of Benefits and Deductible/Co-Pay Responsibility 

Attachment 1-10-03 - Consent to Record 

Policy 1-11 - Respect of Patient Confidentiality, Privacy, Security, and Property 

Policy 1-12 - Care Coordination 

Attachment 1-12-01 - Patient Communication Log 

Policy 1-13 - Patient Responsibility 

Attachment 1-13-01 - Responsibilities of the Patients 

Attachment 1-13-02 - Equipment Purchase Certification 

Chapter 2 

Policy 2-01 - Initial Assessment 

Attachment 2-01-01 - Plan of Care/Initial Assessment: General Equipment 

Attachment 2-01-05 - Plan of Care/Initial Assessment: Continuation 

Policy 2-02 - Reassessments and Follow Up 

Policy 2-03 - Assessment Qualifications 

Policy 2-04 - Patient Abuse, Neglect, and Exploitation 

Policy 2-05 - Plan of Care/Service/Treatment 

Policy 2-06 - Orders for Services 

Policy 2-07 - Care Standards 

Policy 2-08 - Patient Education 

Attachment 2-08-01 - Medicare Supplier Standards 

Attachment 2-08-02 - Delivery Invoice 

Attachment 2-08-03 - Patient Education Sheets - English 

Policy 2-09 - Education Review 

Policy 2-10 - Patient Safety Education 

Policy 2-11 - Patient/Family Medication Education 

Policy 2-12 - Referral, Transfer, and Discharge 

Attachment 2-12-01 - Transfer/Discharge/Referral Notification 

Policy 2-13 - Admission/Refusal of a Patient 

Policy 2-14 - Appropriate and Timely Care 

Policy 2-15 - Initial Respiratory Assessment 

Policy 2-16 - Clinical Respiratory Assessment 

Attachment 2-16-01 - Respiratory Assessment Form 

Policy 2-17 - Plan of Treatment or Care 

Chapter 3 

Policy 3-01 - Governing Body Authority and Responsibility 

Attachment 3-01-01 - Organizational Chart 

Attachment 3-01-02 - Mission Statement 

Policy 3-02 - Organizational Plan 

Policy 3-03 - Patient Perception of Care 

Attachment 3-03-01 - Perception of Care 

Policy 3-04 - Contract Services 

Attachment 3-04-01 - Contract Standards 

Attachment 3-04-02 - Attachment 1: Payment Rates 

Attachment 3-04-03 - Sample Contract: Individual 

Attachment 3-04-04 - Sample Contract: Entity 

Policy 3-05 - Operating Budget 

Policy 3-06 - Administrative Responsibility/Competency/Backup 

Policy 3-07 - Process Implementation and Review 

Attachment 3-07-01 - Process/Policy Action for Non-Compliant Status 

Attachment 3-07-02 - Acknowledgement of Review of Policies 

Chapter 4 

Policy 4-01 - Safety Program 

Policy 4-02 - Cleaning and Disinfecting 

Policy 4-03 - Identifying Risks & Safety Hazards 

Attachment 4-03-01 - Safety Hazard Report (Organization) 

Attachment 4-03-02 - Safety Hazard Report (Patient) 

Policy 4-04 - Incidents 

Attachment 4-04-01 - Incident Report 

Policy 4-05 - Sentinel/Adverse Events 

Policy 4-06 - Equipment Incidents 

Attachment 4-06-01 - Equipment Incident Report 

Attachment 4-06-02 - Equipment Incident Tag 

Policy 4-07 - Emergency Preparedness 

Attachment 4-07-01 - Hazard Vulnerability Analysis 

Policy 4-08 - Equipment Tracking, Hazards, Recalls, and Returns 

Attachment 4-08-01 - Medical Device Registration 

Attachment 4-08-02 - Daily Vehicle Log 

Policy 4-09 - Routine and Preventive Maintenance 

Attachment 4-09-01 - Preventive Maintenance/Repair Log 

Attachment 4-09-02 - Equipment Status Stickers 

Attachment 4-09-03 - Vehicle Maintenance Schedule 

Policy 4-10 - Safe, Operable Equipment 

Attachment 4-10-01 - Warehouse Layout Sample 

Attachment 4-10-02 - General Equipment Log 

Attachment 4-10-03 - Equipment Tracing Number Control Log (Page 1) 

Attachment 4-10-04 – Equipment Tracking Log (Page 2) 

Attachment 4-10-05 – Preventive Maintenance WorkSheet (Page 3) 

Policy 4-11 - Response Procedures 

Attachment 4-11-01 - On-Call Log 

Policy 4-12 - Emergency Maintenance and Replacement 

Policy 4-13 - Staff Safety and Security 

Policy 4-14 - Care/Service at the Organization's Site 

Policy 4-15 - OSHA Compliance 

Attachment 4-15-01 - General Health and Safety Activities Checklist 

Attachment 4-15-02 - Facility Safety Checklist 

Attachment 4-15-03 - Fire Protection Checklist 

Attachment 4-15-04 - Personal Protection Checklist 

Attachment 4-15-05 - Accident Reporting and Record Keeping Checklist 

Attachment 4-15-06 - Medical Services and First Aid Checklist 

Attachment 4-15-07 - Hand and Portable Power-Operated Tool Checklist 

Attachment 4-15-08 - Hoists and Forklifts Checklist 

Attachment 4-15-09 - Flammable and Combustible Material Checklist 

Attachment 4-15-10 - Hazardous Materials, Waste, Disposal, and Exposure Checklist 

Attachment 4-15-11 - Electrical Safety Checklist 

Attachment 4-15-12 - Material Handling Checklist 

Attachment 4-15-13 - Compressors and Compressed Air Checklist 

Attachment 4-15-14 - Compressed Gases Checklist 

Attachment 4-15-15 - Personal Protective Equipment Checklist 

Policy 4-17 - FDA Compliance 

Attachment 4-17-01 - Batch Production Log 

Chapter 5 

Policy 5-01 - Personnel Policies/Procedures 

Policy 5-02 - Employee Qualifications 

Policy 5-03 - Personnel Selection 

Attachment 5-03-01 - Receipt of Job Description 

Attachment 5-03-02 - Job Descriptions 

Policy 5-04 - Supervision 

Policy 5-05 - Staff Orientation 

Attachment 5-05-01 - New Employee Orientation Checklist 

Attachment 5-05-02 - Competency Checklist Page 1 

Attachment 5-05-03 - Competency Checklist Page 2 

Attachment 5-05-04 - Competency Checklist Page 3 

Attachment 5-05-05 - Competency Checklist Page 4 

Policy 5-06 - Staff Education 

Attachment 5-06-01 - Six Steps to Safe Lifting 

Attachment 5-06-02 - Fire Safety 

Attachment 5-06-03 - Basic Home Safety 

Attachment 5-06-04 - Equipment Operation 

Attachment 5-06-05 - Training Outline: Occupational Exposure to Tuberculosis 

Attachment 5-06-06 - Training Outline: Hepatitis B 

Attachment 5-06-07 - Training Outline: Severe Acute Respiratory Syndrome 

Attachment 5-06-08 - Inservice Training Log 

Attachment 5-06-09 - Inservice Training New Product or Process 

Attachment 5-06-10 - Mandatory Annual Inservice Training 

Attachment 5-06-11 - Procedural Checklist: Deliveries 

Attachment 5-06-20 - Procedural Checklists: Enteral Nutrition Pumps 

Policy 5-07 - Staff Competency and Performance Evaluation 

Attachment 5-07-01 - Performance Review 

Attachment 5-07-03 - Delivery Procedures Competency Test 

Attachment 5-07-04 - Equipment Cleaning Competency Test 

Policy 5-08 - Determining and Assessing Learning Needs 

Attachment 5-08-01 - Competency Report 

Policy 5-09 - Clinical Procedures 

Chapter 6 

Policy 6-01 - Information Management Planning 

Attachment 6-01-01 - Information Management Assessment 

Attachment 6-01-02 - Information Management Improvement Plan 

Policy 6-02 - Record Confidentiality, Security, and Integrity 

Policy 6-03 - Record Keeping Authorization/Authentication 

Attachment 6-03-01 - Signature Sheet 

Attachment 6-03-02 - Computer Key/Password Authorization 

Policy 6-04 - Documentation Standardization 

Attachment 6-04-01 - Approved Medical Abbreviations 

Attachment 6-04-02 - Unacceptable Medical Abbreviations, Symbols, and Dose Designations 

Policy 6-05 - Record Review 

Attachment 6-05-01 - Record Review Form 

Policy 6-06 - Patient Documentation 

Policy 6-07 - Record Retention 

Chapter 7 

Policy 7-01 - Infection Control Program 

Policy 7-02 - Occupational Exposure - Prone Task List 

Attachment 7-02-01 - Occupational Exposure Risk and Protection Chart 

Policy 7-03 - Hepatitis B Vaccination 

Attachment 7-03-01 - Hepatitis B Declination 

Policy 7-04 - Infection Control - Universal Precautions 

Policy 7-05 - Equipment Management - Universal Precautions 

Policy 7-06 - Communicable Disease Protection/Exposure 

Policy 7-07 - Health Record 

Policy 7-08 - TB Identification/Prevention Protocols 

Policy 7-09 – Infection, Identification, Monitoring, And Tracking 

Attachment 7-09-01 – Infection Control Monitoring Log (Part 1) 

Attachment 7-09-02 – Infection Control Monitoring Log (Part 2) 

Chapter 8 

Policy 8-01 - Performance Improvement Plan 

Attachment 8-01-01 - Performance Improvement Team Members 

Attachment 8-01-02 - Performance Team Responsibilities 

Attachment 8-01-03 - Staff Responsibilities 

Attachment 8-01-04 - Performance Team Rules 

Attachment 8-01-05 - Meeting Minutes 

Attachment 8-01-06 - Performance Improvement Annual Education Schedule 

Attachment 8-01-07 - Summary Tool for Scope of Service 

Attachment 8-01-08 - Performance Management System Diagram 

Policy 8-02 - Designing Performance Improvement Processes 

Attachment 8-02-01 - Design Worksheet 

Policy 8-03 - Measurement (Data Collection) 

Attachment 8-03-01 - On-Going Monitoring 

Attachment 8-03-02 - Annual Staff Competency Assessment 

Attachment 8-03-03 - Methods of Data Collection 

Attachment 8-03-04 - Sample Check Sheets 

Attachment 8-03-05 - Governing Body Competency Report 

Policy 8-04 - Aggregation and Analysis 

Attachment 8-04-01 - Instructions for Completing the Assessment of Data Form 

Attachment 8-04-02 - Assessment of Data Worksheet 

Policy 8-05 - Performance Improvement 

Attachment 8-05-01 - Improvement Worksheet 

Attachment 8-05-02 - Record of Improvement 

Policy 8-06 - Outcomes Measurement – Benchmarking