8013 - Performance Evaluation - Age-Related Competency - DME Receptionist by compliancedoctor

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medicare regulations for dme and hme companies require this policy if it is applicable to the types of services your dme provides, we make this easy for you with just a small amount of customization, you too will meet the requirements of the federal regulations. this policy is updated to the newest 2010 standards.

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									                                  PERFORMANCE EVALUATION
                                  AGE-RELATED COMPETENCY
                                    (To be completed for all Clinical Personnel)


Name:                                                                              Date:

Position: DME Receptionist                                                 Evaluator:

                                                                                   Unit:

Age Range of Clients to Whom Service is Provided:          Neonate to Geriatric



M = Meets Compliance Criteria                   NC = No Compliance             N/A = Not Applicable for this Staff Member

               COMPLIANCE CRITERIA                         M       NC      N/A               COMMENTS

                                   NEONATE/INFANT (Newborn to 2 yrs)

Maintains safe environment: keeps reception area
free of potential hazards, i.e., small or sharp items.

Always talks to client/parents in a calm, caring
professional manner.

                                            PEDIATRICS (2-11 yrs)

Maintains safe environment: keeps reception area
free of potential hazards, i.e., small or sharp items.

Approaches child in calm manner; uses direct
approach with child; allows for privacy needs
(ages 9-11).

Interacts with client and parents/caregivers in a
calm, caring manner.

                                          ADOLESCENT (12-19 yrs)

Maintains safe environment: keeps reception area
free of potential hazards.

Maintains client confidentiality. Respects client
privacy.

Interacts with client and family in a calm, caring,
professional manner. Does not use
condescending language.

                                                      ADULT

Maintains safe environment: keeps reception area
free of potential hazards.

© The Compliance Doctor, LLC
PERFORMANCE EVALUATION - AGE-RELATED COMPETENCY – DME RECEPTIONIST
(continued)

              COMPLIANCE CRITERIA                         M    NC   N/A   COMMENTS

Encourages family involvement.

Maintains confidentiality and respects privacy.

Interacts with client/family in a calm, caring,
professional manner.

                                                   GERIATRIC

Maintains safe environment: keeps reception area
free of potential hazards.

Allows for possible hearing and/or vision loss,
speaking in lower, louder tones as necessary;
provides additional or brighter lighting, larger print,
etc.

Maintains confidentiality. Respects privacy.

Encourages family support, involving family in
education.




Reference #8013 DME
PERFORMANCE EVALUATION - AGE-RELATED COMPETENCY – DME RECEPTIONIST
(continued)


          Staff Member is Competent to Provide Care and Services to Age Range Indicated


          Staff Member Requires Further Education to Provide Care and Services to Age
           Range Indicated. Scheduled Date of Re-review: _____________________


   Comments:




 Reviewer’s Signature:                                       Review Date:




Reference #8013 DME

								
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