2023 Newly Updated Generic ADULT Policy and Procedure Manual

The forms, documents and policies contained in this 97 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 2023

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.
FULL TABLE OF CONTENTS BELOW

SECTION ONE: FORMS

FOR DIRECT PATIENT CARE:

1. Initial Adult Intake Form
2. Generic Evaluation Forms -Adult OT and PT
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. Patient Satisfaction Survey
10. Referral Source Satisfaction Survey
11. Photo/Video Release Form

SECTION TWO: FORMS/ POLICY STATEMENTS FOR GENERAL OFFICE PROCEDURES

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

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

Addendum added in 2023 – with 8 new forms and Medicare Policy and Procedure Section

(1) Attestation for Waiver of HIPAA Protection During Community Based Therapy Services
(2) Confidentiality and HIPAA Attestation Form for Volunteers, Students, Internships etc.
(3) Opt Out Insurance Form for Clients
(4) No Surprise Good Faith Estimate Form
(5) Template for Stipulation for Payment/Repayment of Continuing Education/Training Course
(6) Notice of Advice/Consent
(7) Patient Billing Acknowledgement Form for Non-Covered Services including Maintenance/Wellness and Elective Services
(8) Patient Consent Form to Use Email Without the Use of Encryption to Exchange Personally Identifiable Information

Terms and Conditions

By purchasing this form, we are granting you the non-exclusive use of this material. You may not re-sell or otherwise transfer the material to another therapist outside of your own practice. By virtue of submitting payment for the course, you hereby are agreeing to the following:

1.Digital Product Usage -After purchasing the form, you will be given immediate access to it and will have lifetime access to use it for your own personal use and business use.

2. Refund Policy- Due to the nature of the form being immediately accessible upon purchasing, no refunds of any fees or other amounts paid by you in connection with the course will be allowed under any circumstances.

3. Warranties and Liability -Every effort is made to ensure that the form is accurate and fit for the use by purchasers However, we take no responsibility whatsoever for the suitability of the form and provide no warranties as to the function or use of the form, whether express, implied or statutory, including without limitation any warranties of merchantability or fitness for particular purpose. You agree to indemnify the creator against all liabilities, claims, demands, expenses, actions, costs, damages, or loss arising out of any breach of these terms and conditions. The creator shall not be liable to you or any third party for consequential, indirect, special or exemplary damages including but not limited to damages for loss of profits, business or anticipated benefits whether arising under tort, contract, negligence or otherwise whether or not foreseen, reasonably foreseeable or advised of the possibility of such damages.

By virtue of submitting payment for the form, the purchaser agrees to abide by the above terms and conditions

SECTION ONE: FORMS

FOR DIRECT PATIENT CARE:

SECTION TWO: FORMS/ POLICY STATEMENTS FOR GENERAL OFFICE PROCEDURES

SECTION THREE: FORMS FOR HIRING THERAPISTS/NON CLINICAL STAFF

SECTION FOUR: BOILER PLATE GENERIC CONTRACTS

$215.00

PRIVATE PRACTICE

2023 Newly Updated Generic ADULT Policy and Procedure Manual

Terms and Conditions

PRIVATE PRACTICE

© All Rights Reserved 2020

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