Get Coordinated Task Plan - Health Mo

The COORDINATED TASK PLAN - Health Mo is essential for facilitating optimal hospice care for residents in long-term care settings. This guide provides clear instructions to help users effectively complete the form online.

Follow the steps to seamlessly complete the form.

1. Press the ‘Get Form’ button to access the Coordinated Task Plan and open it in the provided editor.
2. At the top of the form, fill in the hospice resident's name, room number, and hospice diagnosis.
3. Input the hospice agency's name, daytime and after-hours phone numbers, and the names of assigned hospice staff members, including the RN case manager, hospice aide, chaplain, social worker, and any volunteers.
4. Circle the days of the week for each of the planned hospice nurse visits and document any changes on the following lines.
5. Repeat the circling process for the hospice aide visits and note any changes accordingly.
6. List the planned frequency of visits for the hospice social worker, chaplain, and volunteer, updating the schedule for any ongoing changes.
7. Indicate the wound care schedule by circling the provided days of care and updating with any changes as necessary.
8. Detail each treatment planned, specifying responsibilities for each party and ensuring the frequency is clearly recorded.
9. Checkmark or list the medical supplies and durable medical equipment (DME) provided solely by the hospice.
10. For each new or modified intervention, document a start date, and for discontinued interventions, list an end date.
11. Finally, both the hospice and long-term care (LTC) staff members should sign and date the document at the bottom of the form to confirm that all parties agree with the changes.
12. After multiple changes, consider initiating a new Coordinated Task Plan form for clarity.

Begin completing your Coordinated Task Plan online today for efficient hospice care management.