Health Care Concepts

Manuals
0195 Hospice Policy Manual w/disk $395.00
0200 Home Health Policy Manual w/disk $600.00
0222 Private Duty Policy Manual w/disk $500.00
0245 Pediatric Standards of Care Manual w/disk $75.00
 
Medication Profiles (100 per package)
1301 Drug Classification Form – NCR 2pt $29.00
1330 Medication Profile – Single Page $27.00
1340 Medication Profile – NCR 2pt $29.00
1345 Medication Profile – NCR 3pt $39.00
1341 Continuation Sheet – NCR 2pt $28.00
1341-3 Continuation Sheet – NCR 3pt $39.00
1370 Hi Tech Med Profile – NCR 2pt $29.00
1375 Psychiatric Med Profile – NCR 2pt $29.00
1455 Pediatric Med Profile – NCR 2pt $29.00
1350 Patient Med Profile – 4pg Folder $30.00
1380 Hospice Medication Profile $29.00
 
Drug Classification Indexes
1360 Adult DCI – Package of 5 $25.00
1360 Adult DCI – Package of 10 $50.00
1365 Pediatric DCI – Package of 5 $25.00
1365 Pediatric DCI – Package of 10 $50.00
 
Pediatric Forms (100 per package)
1451 Pediatric Eval – pg 1/3 NCR 2pt $26.00
1452 Pediatric Eval – pg 2/3 NCR 2pt $26.00
1453 Pediatric Eval – pg 3/3 NCR 2pt $26.00
1454 Pediatric Flow Sheet $28.00
1455 Pediatric Med Profile – NCR 2pt $29.00
1456 Pediatric Care Plan – pg 1/2 NCR 2pt $26.00
1457 Pediatric Care Plan – pg 2/2 NCR 2pt $26.00
 
Oasis C Forms (50 per package) Booklet Form
1600B OASIS Start of Care $39.00
1610B OASIS Discharge/Transfer $29.00
1620B OASIS Follow-Up Assessment $30.00
1630 OASIS Patient Tracking Sheet $10.00
1650 OASIS Transfer ONLY $14.00
1700B Therapy OASIS SOC $39.00
1710B Therapy OASIS Disch/Transfer $29.00
1720B Therapy OASIS Follow-Up/Recertification $30.00
1900 Mental Health Start of Care $48.00
1910 Mental Health Discharge/Transfer $29.00
1920 Mental Health Follow-Up Assessment $34.00
 
Private Duty (100 per package)
1800 Request for Service – NCR 3pt $38.00
1810 Client Profile – NCR 3pt $38.00
1820 Admission Evaluation – NCR 3pt $38.00
1830 HC Asst. Plan of Care – NCR 3pt $38.00
1840 HC Asst. Service Note – NCR 3pt $38.00
1850 Client Eval/Follow-Up – NCR 3pt $38.00
1860 Client Agree/Consent – NCR 3pt $38.00
1870 Service Agreement – NCR 3pt $38.00
1880 Emerg Preparedness – NCR 2pt $26.00
1890 Auto Waiver/Liability – Single Page $23.00
1891 Rights/Responsibilities – NCR 2pt $26.00
1892 Nursing Evaluation – 4pg Folder $30.00
 
Other Forms (100 per package)
1010 Aide Activity Note – Single Page $23.00
1020 Aide Assignment – NCR 2pt $26.00
1025 Field Supervisor Competency Assess $26.00
1040 Comprehensive Care Plan – Single Page $24.00
1050 Comprehensive Care Plan – pg 1/2 NCR 2pt $26.00
1060 Comprehensive Care Plan – pg 2/2 $26.00
1485 Skilled Prof Supervision/Eval – NCR 2pt $26.00
1080 Care Plan-Phys/Oc Therapy – pg 1/2 NCR 2pt $26.00
1090 Care Plan-Phys/Oc Therapy – pg 2/2 NCR 2pt $26.00
1290 Clinical Record Review – 4pg Folder $30.00
1310 Med. Social SVCS Eval – pg 1/2 NCR 2pt $26.00
1320 Med. Social SVCS Eval – pg 2/2 NCR 2pt $26.00
1430 Occupational Therapy Eval – pg 1/2 NCR 2pt $26.00
1440 Occupational Therapy Eval – pg 2/2 NCR 2pt $26.00
1460 Physical Therapy Eval – pg 1/2 NCR 2pt $26.00
1470 Physical Therapy Eval – pg 2/2 NCR 2pt $26.00
1471 Physical Therapy Visit – pg 1/2 NCR 2pt $26.00
1472 Physical Therapy Visit – pg 2/2 NCR 2pt $26.00
1480 Skilled Nurse Visit Note $23.00
1490 Clinical Note – Single Page $23.00
1500 Referral – NCR 3pt $38.00
1510 Speech Therapy Eval – pg 1/2 NCR 2pt $26.00
1520 Speech Therapy Eval – pg 2/2 NCR 2pt $26.00
1550 Patient Teaching Record – 4pg Folder $30.00
1660 Face to Face Physician Encounter (padded) $10.00
1660 Face to Face Physician Encounter - NCR 2pt $28.00
 
2 Hole/Top Punch (50 per package)
1600T OASIS Start of Care $39.50
1610T OASIS Discharge/Transfer $29.50
1620T OASIS Follow-Up Assessment $30.50
 
Spanish Forms
0095S Patient Rights & Responsibilities – 4pg Folder $30.00
1343 Patient Med Profile Spanish – 4pg Folder $30.00



Weatherbee

Clinical Documentation System For Hospice (1 Part no NCR)   (2 Part NCR)   (3 Part NCR)
CL265 Bereavement Plan of Care $16.50   $51.00   $76.50
CL190 Bereavement Risk Assessment $16.50   $51.00   $76.50
CL280 Care Coordination Sheet $9.69   $25.50   $38.25
CL335 Certification of Terminal Illness $9.69   $25.50   $38.25
CL145 Comprehensive Hospice Assessment Cvr Pg $9.69   $25.50   $38.25
CL175 Comprehensive Psychological Assessment $22.19   $70.63   $107.25
CL185 Comprehensive Spiritual Assessment $22.19   $70.63   $107.25
CL200 Determining Terminal Status: Adult Failure To Trive Worksheet $16.50        
CL215 Determining Terminal Status: ALS Worksheet $16.50        
CL225 Determining Terminal Status: Alzheimer's and Related Disorders Worksheet $16.50        
CL220 Determining Terminal Status: Cancer Worksheet $16.50        
CL195 Determining Terminal Status: Decline in Clinical Status Worksheet $16.50        
CL230 Determining Terminal Status: Heart Disease Worksheet $16.50        
CL235 Determining Terminal Status: HIV Worksheet $16.50        
CL240 Determining Terminal Status: Liver Disease Worksheet $16.50        
CL245 Determining Terminal Status: Pulmonary Disease Worksheet $16.50        
CL205 Determining Terminal Status: Renal Disease Worksheet $16.50        
CL250 Determining Terminal Status: Stroke-Coma Worksheet $16.50        
CL290 Drug Profile $16.50   $51.00   $76.50
CL295 Drug Profile Cover Page $9.69   $25.50   $38.25
CL285 Drug Profile Review $16.50   $51.00   $76.50
CL155 Fall Risk Assessment $9.69   $25.50   $38.25
CL180 Financial Assessment $16.50   $51.00   $76.50
CL110 Hospice Aide Flow Sheet $26.75   $70.63   $107.25
CL260 Hospice Aide Plan of Care     $51.00   $76.50
CL100 Hospice Aide Longitudinal Data Assessment Tool $37.50        
CL105 Hospice LDAT - Quick Reference Guide $10.00        
CL255 Hospice Plan of Care $41.25   $131.25   $211.00
CL255a Hospice Plan of Care Change $13.75   $25.50   $38.25
CL275 IDG Review & Update to Hospice Plan of Care $22.19   $70.63   $107.25
CL150 Initial & Comprehensive Nursing Assessment $55.00   $173.00   $280.20
CL130 Medicare Hospice Revocation Form $9.69   $25.50   $38.25
CL140 Medicare/Medicaid Statement of Consent $9.69   $25.50   $38.25
CL300 Nursing Assessment Update $47.19   $157.50   $245.60
CL315 Nursing Clinical Note $22.19   $70.63   $107.25
CL160 Physical Pain Assessment $16.50   $51.00   $76.50
CL345 Physician/NP Face-to-Face Encounter Note $9.69   $25.50   $38.25
CL135 Physician Orders and Medication Record     $75.63    
CL330 Progress Note $9.69   $25.50   $38.25
CL305 Psychosocial Assessment Update $22.19   $70.63   $107.25
CL320 Psychosocial/Spiritual Clinical Note $9.69   $25.50   $38.25
CL340 Recertification of Terminal Illness $9.69   $25.50   $38.25
CL350 Recertification of Terminal Illness - Second 90-Day Period $9.69   $25.50   $38.25
CL170 Safety Assessment $16.50   $51.00   $76.50
CL165 Skin Impairment Assessment $16.50   $51.00   $76.50
CL310 Spiritual Asessment Update $22.19   $70.63   $107.25
CL325 Volunteer Note $9.69   $25.50   $38.25
 
Determining Terminal Status (1 Part no NCR)
CL200 Adult Failure To Trive Worksheet $16.50
CL215 ALS Worksheet $16.50
CL225 Alzheimer's and Related Disorders Worksheet $16.50
CL220 Cancer Worksheet $16.50
CL195 Decline in Clinical Status Worksheet $16.50
CL230 Heart Disease Worksheet $16.50
CL235 HIV Worksheet $16.50
CL240 Liver Disease Worksheet $16.50
CL245 Pulmonary Disease Worksheet $16.50
CL205 Renal Disease Worksheet $16.50
CL250 Stroke-Coma Worksheet $16.50


TAG Products

 
Home Care Forms (100 per package)
0001 Skilled Intake Referral $23.00
0002 Admissions Orders Page 1 of 2 $28.00
0003 Admissions Orders Page 2 of 2 $28.00
0004 Supplemental Physicia's Order/Communication $28.00
0005 Post Hospital Orders $28.00
0006 Cover Letter For Physician's Order $23.00
0007 Skilled Service Agreement $28.00
0008 Medical Guidlines for Determining Eligibility $27.00
0009 Medicare Election Statement $28.00
0010 Skilled Insurance Verification/Authorization $23.00
0011 Medicare Questionnaire $28.00
0012 Notification of Clients Choice - Home Health Provider $28.00
0013 Consent & Verification of Receipt of Information $28.00
0014 Emergency Procedures $28.00
0015 Client Worksheet Disaster Preparedness Plan $28.00
0016 Notification of Expedite/Emergency $28.00
0017 Telephone Monitoring Waiver $28.00
0018 Discharge Summary $28.00
0019 Discharge Instructions $28.00
0020 60 Day Progress/Summary Note/Team Conference $28.00
0021 Patient Discharge Information $39.00
0022 Change in Patient Information $28.00
0023 Inpatient Nurse Visit Report $28.00
0024 Skilled Visit Addendum $23.00
0025 Missed Visit Report $28.00
0026 Patient Home Chart Flow Sheet $23.00
0027 Medication Administration Flow Sheet $27.00
0066 Medication Prefill Flow Sheet $27.00
0028 Change of Status $28.00
0029 Management & Evaluation Note $27.00
0030 Coordination of Care $23.00
0031 Interdisciplinary Visit Note $28.00
0032 Plan of Care Unscheduled IDG $28.00
0033 Occupational Therapy Visit Note $28.00
0034 Infection Identification: Patient Report $28.00
0036 Addendum Note for IV Therapy $27.00
0037 Addendum Note for Wound Care $27.00
0038 Long Term Care: Fall Risk Assessment Form $27.00
0039 Medication Director Self Time Tracker $23.00
0040 Medical Director Services $23.00
0042 Request for Reference $28.00
0043 Backup Service Agreement $23.00
0095 Patient Rights and Responsibilities $30.00
 
Private Agency Forms (100 per package)
0044 Agreement for Caregiver Arrangement $28.00
0045 PHC/HMC Attendant Orientation/Supervisory Report $78.00
0046 Loss of Medicare Eligibility $28.00
0047 Aid Assignment Sheet $28.00
0048 Aid Visit Note $23.00
0049 Personal Care Visit Note $39.00
0050 Personal Care Assignment Sheet $39.00
0051 Personal Attendant Services Instruction to Worker $27.00
0052 Daily Timesheet $28.00
0053 Patient Visit Confirmation $23.00
0054 Notification of Attendant/Schedule Change $50.00
0055 Supervisory Visit & Orientation Attestation $28.00
0056 Communication Form $23.00
0057 Complaint Form $39.00
 
Hospice Forms (100 per package)
0058 Palliative Performance Scale (PPS)/Functional Assessment Staging (FAST) $28.00
0059 Hospice Physician's Visit $28.00
0060 Supplemental Physician's Order/Communication $28.00
0061 Report of Death & Drug Disposal $28.00
0062 Nursing Facility Notification of Hospice Admission and Notification of Change $28.00
0063 Hospice Revocation Statement $28.00
0064 Change of Disignated Hospice Request (Transfer Request) $28.00
 
Other Products
Guidelines for Home Health Admission
Quantity 100 250 500 750 1000 2000 2500
Price/EA $7.39 $6.09 $5.68 $5.55 $5.38 $5.28 $4.98
 
Guidelines for Hospice Admission
Quantity 25 50 100 250 500 1000
Price/EA $10.48 $8.69 $6.84 $5.64 $5.26 $4.98
 
Home Health Screening Questionnaire (25 sheet pad)
Quantity 50 100 250 500 750 1000
Price/EA $4.18 $3.10 $2.11 $1.53 $1.35 $1.27
 
Home Health Screening Questionnaire (50 sheet pad)
Quantity 50 100 250 500 750 1000
Price/EA $6.20 $5.07 $2.91 $2.31 $2.14 $2.05
 
Physician’s Guide to Face–to–Face (Home Health)
Quantity 250 500 750 1000
Price/EA $1.47 $0.79 $0.55 $0.45
 
Physician’s Guide to Face–to–Face (Hospice)
Quantity 250 500 750 1000
Price/EA $1.47 $0.79 $0.55 $0.45