Notes_ALF_CE

ALF Visit Note
ALL VISIT NOTES ARE REQUIRED TO BE COMPLETED AND SUBMITTED AT THE END OF VISIT - PRIOR TO LEAVING FACILITY.

DO NOT EXIT FACILITY PRIOR TO COMPLETING THE ALF NOTE FOR ALL VISITS
Home Health or Hospice?*

Home HealthHospice
Patient First Name*
Patient Last Name*
Room Number*
Actual Visit Date*

MonthDayYear
Date
Community Name (Please Ensure This is Correct)*
If a new facility is not listed in this list, please email ceit@caringedge.com with facility name, address and facility email address or fax number. Having these 3 key pieces will allow us to add to the note delivery system quickly. Thanks!
Reason for Visit:*
Examples: Admit, Recert, Regular Visit, Discharge Visit, etc.
Service Provided:*
Examples: Skilled Nursing, PT, OT, CNA, etc.
Concerns - If Any:

0/1000
Instructions/Visit Notes: (Keep it simple and to the point) DO NOT COPY YOUR VISIT NARRATIVE UNDER ANY CIRCUMSTANCES*

0/2000
Wound Measurements: Please make sure to add wound measurements to your Narrative

Aide Visit Note Examples:
- All aid cares performed as care planned, no issues identified. Updated _(name)_ CM and facility staff __(name)__. Continue with current care plan.
- Patient declined (hair wash/Shower); all other aid cares performed as care planned. No other issues identified. Updated _(name)_ CM and facility staff __(name)__. Continue with current care plan.
- Patient declined all aid cares, no other issues identified. Updated _(name)_ CM and facility staff __(name)__. Continue with current care plan.
- Patient given bed bath, per case manager instructions. All other aid cares performed as care planned. No other issues identified. Updated _(name)_ CM and facility staff __(name)__. Continue with current care plan.
Volunteer Example:
- Seen for Volunteer Services. Care planned followed.
Nursing Examples:
- Patient seen by nursing for routine visit. SN worked towards patient centered goals developed in POC. Patient continues to make good progress. Care plan followed.
- Patient seen for Hospice nursing visit. SN continues to work towards symptom management and comfort care.. Care plan followed.
Clinician Electronic Signature (Required)
Staff First and Last Name*
Staff Title (RN, PT, CNA, OT, Chaplain, Volunteer, etc)*
Staff Email Address(Verify Spelling and @myallcare.net) Note Confirmation Will Be Sent to This Address:*
first.last@myallcare.net
BEFORE YOU SUBMIT! PLEASE DOUBLE CHECK THAT THE PATIENT'S NAME, YOUR FIRST AND LAST NAME AND VISIT DATES ARE CORRECT. THIS IS A MEDICAL RECORD AND MUST BE ACCURATE.
Should be Empty:

ALF Visit Note

ALL VISIT NOTES ARE REQUIRED TO BE COMPLETED AND SUBMITTED AT THE END OF VISIT - PRIOR TO LEAVING FACILITY.

Clinician Electronic Signature (Required)

BEFORE YOU SUBMIT! PLEASE DOUBLE CHECK THAT THE PATIENT'S NAME, YOUR FIRST AND LAST NAME AND VISIT DATES ARE CORRECT. THIS IS A MEDICAL RECORD AND MUST BE ACCURATE.