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EVV
Home
About
Services
Skilled Services
Nursing Services
Wound Care
Ostomy Care
Catheter Care
G-Tube Feeding
Vital Signs Monitoring And Report To PCP Doctor
Safety Supervision
Symptom Monitoring
Mobility Support
Speech Therapy
Evaluation/Diagnosis/Prevention of speech impairment
Swallow evaluation and management
Cognitive communication
Medical Social Worker
Providing adequate resources for clients in the community
Implement Short/long term planning of care
Physical Therapy
Improve Mobility & Strength
Aid inside/outside ambulation
Range of motion, Positioning & Transfers
Balancing & Gait
Create an exercise plan
Occupational Therapy
Restore Function
Promote ADL functions
Non-Skilled Services
Home Health Aide
Medication reminders
Vital signs monitoring & Report to Clinical Nurse
Mobility support
Forms
Administrator Competency & Job Description Form
Clinical Manager Job Description Form
Home Health Aide Competency & Job Description & Skill Validation
LPN Competency Job Description Form
MSW Competency Job Description Form
Occupational Therapist Assistant Job Description Form
Occupational Therapist Job Description Form
Physical Therapist Assistant Job Description Form
Physical Therapist Job Description Form
RN Job Description & Performance Evaluation & Competency Form
Speech Therapist Job Description Form
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Speech Therapist Initial Competency
Speech Therapist Initial Competency
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Name
(Required)
Date of Hire
(Required)
MM slash DD slash YYYY
Date Completed
(Required)
MM slash DD slash YYYY
Demonstrates ability to process paperwork and associated tasks related to:
1) Self-Assessment
Proficient
Need Review
No Experience
1. Initial Evaluation
Initial therapy evaluation
Develops care plan based on assessment
Health history/physical exam
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2. OASIS Documentation
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
Need Review
No Experience
3.Care coordination/discharge planning
Care planning
Care coordination
Case management
Documents and reports key information to physician, RN Case Manager, supervisor, care team
Coordinates community resources
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
Need Review
No Experience
4. Transfer of patient
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficient
Need Review
No Experience
5. Documentation
CMS/state guidelines for documentation
Adheres to plan of care
Corrections to the clinical record
Accident/incident reports
Clinical notes
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficient
Need Review
No Experience
6. Other
Supervision of ancillary personnel
Supply and DME management
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Assessment/Evaluation:
1) Self-Assessment
Proficient
Need Review
No Experience
1. Mental Status/Cognition/Communication
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2. Verbal/non-verbal expression
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
3) Self-Assessment
Proficient
Need Review
No Experience
3.Graphic expression
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
Need Review
No Experience
4. Auditory comprehension
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficient
Need Review
No Experience
5. Reading comprehension
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficient
Need Review
No Experience
6.Visual comprehension
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
7) Self-Assessment
Proficient
Need Review
No Experience
7. Speech intelligibility
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
8) Self-Assessment
Proficient
Need Review
No Experience
8. Voice
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
9) Self-Assessment
Proficient
Need Review
No Experience
9. Prosody
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
10) Self-Assessment
Proficient
Need Review
No Experience
10.Oral/motor functions
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
11) Self-Assessment
Proficient
Need Review
No Experience
11. Functional skills
Loss of food/drooling
Bolus control
Transit time
Swallowing reflex
Coughing/choking
Vocal quality
Pocketing/stasis
Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
12) Self-Assessment
Proficient
Need Review
No Experience
12. Environment evaluation / barriers
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
13) Self-Assessment
Proficient
Need Review
No Experience
13. Equipment/assistive device needs
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
14) Self-Assessment
Proficient
Need Review
No Experience
14. Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Skilled Treatments/Interventions:
1) Self-Assessment
Proficient
Need Review
No Experience
1.Therapeutic activities
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2.Speech articulation disorders
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
Need Review
No Experience
3. Language disorders
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
Need Review
No Experience
4. Non-verbal communication
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficient
Need Review
No Experience
5. Language processing
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficient
Need Review
No Experience
6. Therapy to increase articulation, proficiency, verbal expression
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
7) Self-Assessment
Proficient
Need Review
No Experience
7. Dysphagia instruction/treatments
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
8) Self-Assessment
Proficient
Need Review
No Experience
8. Develop/teach communication system
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
9) Self-Assessment
Proficient
Need Review
No Experience
9. Voice disorders
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
10) Self-Assessment
Proficient
Need Review
No Experience
10. Aural rehabilitation
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
11) Self-Assessment
Proficient
Need Review
No Experience
11. Alaryngeal speech skills
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
12) Self-Assessment
Proficient
Need Review
No Experience
12. Food texture recommendations
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
13) Self-Assessment
Proficient
Need Review
No Experience
13.Swallow/vocal skills exercises
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
14) Self-Assessment
Proficient
Need Review
No Experience
14. Care of voice prosthesis
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
15) Self-Assessment
Proficient
Need Review
No Experience
15.Tracheostomy care/management education
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
16) Self-Assessment
Proficient
Need Review
No Experience
16. Pain assessment/management
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
17) Self-Assessment
Proficient
Need Review
No Experience
17. Safety/fall prevention
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
18) Self-Assessment
Proficient
Need Review
No Experience
18.Miscellaneous Skills
Vital signs
Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
19) Self-Assessment
Proficient
Need Review
No Experience
19. Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Use of Equipment/Modalities:
1) Self-Assessment
Proficient
Need Review
No Experience
1. NMES
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2. Other
Eval Method
Verbal Test
Written Test
Demo
Infection Control
1) Self-Assessment
Proficient
Need Review
No Experience
1. Hand hygiene technique
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2. Proper bag technique
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
Need Review
No Experience
3. Personal protective equipment
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
Need Review
No Experience
4. Exposure control plan
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficient
Need Review
No Experience
5. TB exposure control plan
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficient
Need Review
No Experience
6. Reporting of infections for patient and personnel
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
7) Self-Assessment
Proficient
Need Review
No Experience
7. Standard precautions
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Safety
1) Self-Assessment
Proficient
Need Review
No Experience
1. Assessment of patient safety risks and home safety
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2. Emergency preparedness
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
Need Review
No Experience
3. Fire extinguishers
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
Need Review
No Experience
4. Hazardous materials
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Patient Education
1) Self-Assessment
Proficient
Need Review
No Experience
1. Determines patient / family learning needs
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
Need Review
No Experience
2. Sets measurable objectives
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
Need Review
No Experience
3. Develops/implements teaching plan
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
Need Review
No Experience
4. Evaluates effectiveness of teaching
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficient
Need Review
No Experience
5. Revises teaching plan based on patient needs
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficient
Need Review
No Experience
6. Documents response to teaching
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Δ
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Home
About
Services
Skilled Services
Nursing Services
Wound Care
Ostomy Care
Catheter Care
G-Tube Feeding
Vital Signs Monitoring And Report To PCP Doctor
Safety Supervision
Symptom Monitoring
Mobility Support
Speech Therapy
Evaluation/Diagnosis/Prevention of speech impairment
Swallow evaluation and management
Cognitive communication
Medical Social Worker
Providing adequate resources for clients in the community
Implement Short/long term planning of care
Physical Therapy
Improve Mobility & Strength
Aid inside/outside ambulation
Range of motion, Positioning & Transfers
Balancing & Gait
Create an exercise plan
Occupational Therapy
Restore Function
Promote ADL functions
Non-Skilled Services
Home Health Aide
Medication reminders
Vital signs monitoring & Report to Clinical Nurse
Mobility support
Forms
Administrator Competency & Job Description Form
Clinical Manager Job Description Form
Home Health Aide Competency & Job Description & Skill Validation
LPN Competency Job Description Form
MSW Competency Job Description Form
Occupational Therapist Assistant Job Description Form
Occupational Therapist Job Description Form
Physical Therapist Assistant Job Description Form
Physical Therapist Job Description Form
RN Job Description & Performance Evaluation & Competency Form
Speech Therapist Job Description Form
Resources
Employement
Alora/EVV
Alora
EVV
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