2020 Generic Policy and Procedure Manual for Pediatric Private Practice

The forms, documents and policies contained in this 107 page manual have been compiled by Iris Kimberg, MS PT OTR. It is sold as a word document, not a PDF file so that you can edit each page as you see fit – ie. with practice name, etc. Newly updated in 2020

All practices are unique and reflect the individuals that are their creators. Yet there are commonalities that must be present in all practices by virtue of the fact that we are all compelled by similar professional practice acts, work and professional ethics as well as state and federal regulations including OSHA and HIPAA.

The purpose of this book is to offer generic guidelines, policies and forms from which a therapist can then customize their own policies, procedures and forms to best meet their individual practices. Remember that policy and procedure manuals should be reviewed yearly and updated as often as necessary to reflect current standards of practice, new regulations and any changes in state and federal law.  Table of contents below

Table of Contents

SECTION ONE:  FORMS
FOR DIRECT PATIENT CARE:

1.  Initial Pediatric Intake Form
2.  Generic Evaluation Forms  -Pediatric OT, PT, ST
3.  Generic Progress Re-evaluation Note
4.  Generic Discharge Form
5.  Assignment of Benefits Form/Patient Notification of Billing/Cancellation/Discontinuance of Services Policy/Financial Policy Form
6.  Pre and Prompt Payment Discount and Financial Hardship Waivers
7.  Authorization for Release of Confidential Information
8.  Notice of Patient Privacy Practice/ Patient Information Consent Form
9.  Pediatric Patient Satisfaction Survey
10.  Referral Source Satisfaction Survey
11.  Pediatric Photo/Video Release Form
12. Caretaker Permission Form
13. Onsite Class Waiver Form

SECTION TWO: FORMS/ POLICY STATEMENTS FOR GENERAL OFFICE PROCEDURES

1.  Incident Reporting and Form
2. Reporting of Child Abuse
3.  Confidentiality, Release and Handling of Information including HIV Information
4.  Confidentiality for Emails/Faxes
5.  Emergency Preparedness Plan and Business Interruption Plan
6.  Health and Safety Issues Including Universal Precautions, Infection Control/  Handwashing Procedures
7.  HIPAA Policy and Procedures  and Business Associates Agreement  BAA for HIPAA
8.  Clinical Chart Review Form
9. Policy for Management of Lice
10. Vaccine Policy Statement

SECTION THREE: FORMS FOR HIRING THERAPISTS/NON CLINICAL STAFF

1.  Application Form, Orientation and Minimum Requirements of Therapists
2.  Reference Forms
3.  Clinical Competency Review Form
4.  Employee Health Assessment
5.  Hepatitis B Consent/Decline Form
6.  Freedom from Impairment Form
7.  On Site Clinical Competency Form
8.  Sample Employee Handbook
9.   Code of Ethics  – OT, PT ST

SECTION FOUR:  BOILER PLATE GENERIC CONTRACTS

1. Sample Temporary Personnel Services Agreement
2. Sample Home Care Personnel Services Agreement
3.  Sample Contract for School District Service Provision
4.  Sample Independent Contractor Agreement
5.  Sample Employee Contract
6. Job Descriptions  OT, OTA,  PT, PTA, Practice Manager
7. Non Disclosure Agreement

$160.00