{"id":31648,"date":"2023-09-18T05:11:31","date_gmt":"2023-09-18T05:11:31","guid":{"rendered":"https:\/\/www.process.st\/templates\/discharge-planning-checklist-for-skilled-nursing-facility\/"},"modified":"2024-03-05T14:07:15","modified_gmt":"2024-03-05T14:07:15","slug":"discharge-planning-checklist-for-skilled-nursing-facility","status":"publish","type":"post","link":"https:\/\/www.process.st\/templates\/discharge-planning-checklist-for-skilled-nursing-facility\/","title":{"rendered":"Discharge Planning Checklist for Skilled Nursing Facility"},"content":{"rendered":"\n<section id=\"identify-residents-discharge-goals\"> \n <h2>Identify resident's discharge goals<\/h2>\n <div class=\"text-content\">\n   In this task, you will identify the resident's goals for discharge from the skilled nursing facility. This includes understanding what the resident hopes to achieve, any concerns they may have, and their preferences for aftercare. By understanding the resident's goals, we can tailor the discharge plan to meet their individual needs and maximize their chances of successful transition back into the community. \n <\/div> \n <div class=\"textarea-field-content form-field-content\"> \n  <div class=\"form-group\"> <label> Describe the resident's discharge goals <\/label> <textarea placeholder=\"Something will be typed here...\" rows=\"3\" disabled class=\"form-control\"><\/textarea> \n  <\/div> \n <\/div> \n<\/section> \n<section id=\"assess-residents-physical-health-and-wellbeing\"> \n <h2>Assess resident's physical health and well-being<\/h2>\n <div class=\"text-content\">\n   This task involves assessing the resident's physical health and well-being prior to discharge from the skilled nursing facility. It is important to ensure that the resident is medically stable and able to manage their care needs independently or with appropriate support. By conducting a thorough assessment, we can identify any potential risks or concerns and address them proactively. \n <\/div> \n <div class=\"multi-select-content form-field-content\"> \n  <div class=\"form-group\"> <label> Perform a comprehensive physical health assessment <\/label> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Vital signs \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Mobility assessment \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Nutritional assessment \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Skin assessment \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       5 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Medication review \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"review-medication-regimen\"> \n <h2>Review medication regimen<\/h2>\n <div class=\"text-content\">\n   In this task, you will review the resident's medication regimen to ensure that it is accurate and appropriate for their needs post-discharge. This includes confirming the medications they are currently taking, checking for any potential interactions or contraindications, and making any necessary adjustments or recommendations. By reviewing the medication regimen, we can help ensure the resident's safety and optimize their medication management. \n <\/div> \n <div class=\"multi-select-content form-field-content\"> \n  <div class=\"form-group\"> <label> Review the resident's medication regimen <\/label> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Confirm current medications \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Check for interactions or contraindications \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Make recommendations for adjustments \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"consult-with-interdisciplinary-team\"> \n <h2>Consult with interdisciplinary team<\/h2>\n <div class=\"text-content\">\n   This task involves consulting with the interdisciplinary team to gather input and collaborate on the resident's discharge plan. This includes healthcare professionals from various disciplines, such as nursing, therapy, social work, and pharmacy. By consulting with the interdisciplinary team, we can ensure that all aspects of the resident's care are considered and integrated into the discharge plan. \n <\/div> \n <div class=\"multi-choice-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select the disciplines involved in the interdisciplinary team <\/label> <select disabled class=\"form-control\"> <option value=\"\">Multiple options can be selected from this list<\/option> <\/select> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Nursing \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Therapy \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Social work \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Pharmacy \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       5 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Other \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n <div class=\"members-field-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select team members who will be involved in the consultation <\/label> <select disabled class=\"form-control\"> <option value=\"A member or group will be selected here\">A member or group will be selected here<\/option> <\/select> \n  <\/div> \n <\/div> \n<\/section> \n<section id=\"planning-appropriate-discharge-setting\"> \n <h2>Planning appropriate discharge setting<\/h2>\n <div class=\"text-content\">\n   In this task, you will plan the appropriate discharge setting for the resident based on their individual needs and preferences. This may include returning home, transitioning to an assisted living facility, or accessing other community-based resources. By identifying the most suitable discharge setting, we can support the resident's recovery and prevent unnecessary readmissions to the skilled nursing facility. \n <\/div> \n <div class=\"select-field-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select the appropriate discharge setting <\/label> <select disabled class=\"form-control\"> <option value=\"An option will be selected here\">An option will be selected here<\/option> <\/select> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Returning home \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Assisted living facility \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Community-based resources \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Other \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"arrange-home-modifications-if-necessary\"> \n <h2>Arrange home modifications if necessary<\/h2>\n <div class=\"text-content\">\n   This task involves arranging any necessary home modifications to ensure that the resident's living environment is safe and supportive of their needs post-discharge. This may include installing grab bars, ramps, or other accessibility features. By making appropriate home modifications, we can help facilitate the resident's successful transition back into their home. \n <\/div> \n <div class=\"multi-choice-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select the necessary home modifications <\/label> <select disabled class=\"form-control\"> <option value=\"\">Multiple options can be selected from this list<\/option> <\/select> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Grab bars \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Ramps \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Accessible bathroom modifications \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Other \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"organize-required-medical-equipment-for-home-use\"> \n <h2>Organize required medical equipment for home use<\/h2>\n <div class=\"text-content\">\n   In this task, you will organize the required medical equipment for the resident's use at home. This may include items such as a walker, wheelchair, or oxygen concentrator. By ensuring that the resident has the necessary medical equipment, we can support their safety and independence post-discharge. \n <\/div> \n <div class=\"multi-choice-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select the required medical equipment for home use <\/label> <select disabled class=\"form-control\"> <option value=\"\">Multiple options can be selected from this list<\/option> <\/select> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Walker \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Wheelchair \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Oxygen concentrator \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Other \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"arrange-home-health-services-if-needed\"> \n <h2>Arrange home health services if needed<\/h2>\n <div class=\"text-content\">\n   This task involves arranging any necessary home health services for the resident post-discharge. This may include nursing care, therapy services, or assistance with activities of daily living. By arranging appropriate home health services, we can provide the resident with the support they need to continue their recovery at home. \n <\/div> \n <div class=\"multi-choice-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select the required home health services <\/label> <select disabled class=\"form-control\"> <option value=\"\">Multiple options can be selected from this list<\/option> <\/select> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Nursing care \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Therapy services \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Assistance with activities of daily living \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Other \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"create-a-detailed-care-plan-for-discharge\"> \n <h2>Create a detailed care plan for discharge<\/h2>\n <div class=\"text-content\">\n   In this task, you will create a detailed care plan for the resident's discharge from the skilled nursing facility. This includes outlining the specific care tasks, medications, and interventions that will be needed post-discharge. By creating a detailed care plan, we can ensure that the resident's care needs are clearly communicated and understood by all involved. \n <\/div> \n <div class=\"textarea-field-content form-field-content\"> \n  <div class=\"form-group\"> <label> Describe the detailed care plan for discharge <\/label> <textarea placeholder=\"Something will be typed here...\" rows=\"3\" disabled class=\"form-control\"><\/textarea> \n  <\/div> \n <\/div> \n<\/section> \n<section id=\"discuss-care-plan-with-resident-and-family\"> \n <h2>Discuss care plan with resident and family<\/h2>\n <div class=\"text-content\">\n   This task involves discussing the care plan with the resident and their family to ensure their understanding and agreement. This includes explaining the care tasks, medications, and interventions that will be implemented post-discharge. By discussing the care plan, we can address any questions or concerns and ensure that the resident and their family are actively involved in the decision-making process. \n <\/div> \n <div class=\"multi-select-content form-field-content\"> \n  <div class=\"form-group\"> <label> Discuss the care plan with the resident and family members <\/label> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Explain care tasks \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Review medications \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Address concerns or questions \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Obtain consent for the care plan \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       5 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Provide written instructions \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"approval-physician-review-of-care-plan\"> \n <h2>Approval: Physician Review of Care Plan<\/h2>\n <div class=\"approval-content\"> \n  <div class=\"header\"> \n   <div class=\"list-title\">\n    Will be submitted for approval:\n   <\/div> \n  <\/div> \n  <div class=\"approval-rule-subject-tasks-list\"> \n   <ul class=\"list\"> \n    <li> \n     <div class=\"approval-rule-subject-tasks-list-item\"> \n      <div class=\"item\"> \n       <div class=\"container\"> <span class=\"title\">Create a detailed care plan for discharge<\/span> \n        <div class=\"body\">\n         Will be submitted\n        <\/div> \n       <\/div> \n      <\/div> \n     <\/div> <\/li> \n   <\/ul> \n  <\/div> \n <\/div> \n<\/section> \n<section id=\"coordinate-with-social-services-for-assistance-if-needed\"> \n <h2>Coordinate with social services for assistance if needed<\/h2>\n <div class=\"text-content\">\n   This task involves coordinating with social services to explore available resources and support services that may be beneficial to the resident post-discharge. This includes assistance with financial resources, transportation, or social support networks. By coordinating with social services, we can help address any social determinants of health that may impact the resident's successful transition back into the community. \n <\/div> \n <div class=\"multi-choice-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select the type of assistance needed from social services <\/label> <select disabled class=\"form-control\"> <option value=\"\">Multiple options can be selected from this list<\/option> <\/select> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Financial resources \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Transportation \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Social support networks \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Other \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n <div class=\"members-field-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select the social services representative who will be involved in the coordination <\/label> <select disabled class=\"form-control\"> <option value=\"A member or group will be selected here\">A member or group will be selected here<\/option> <\/select> \n  <\/div> \n <\/div> \n<\/section> \n<section id=\"schedule-followup-appointments\"> \n <h2>Schedule follow-up appointments<\/h2>\n <div class=\"text-content\">\n   In this task, you will schedule the necessary follow-up appointments for the resident post-discharge. This may include appointments with primary care providers, specialists, or therapy services. By scheduling appropriate follow-up appointments, we can ensure that the resident's health and well-being continue to be monitored and any necessary interventions are implemented. \n <\/div> \n <div class=\"multi-select-content form-field-content\"> \n  <div class=\"form-group\"> <label> Schedule the necessary follow-up appointments <\/label> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Primary care provider \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Specialist \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Therapy services \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Other \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"provide-instructions-for-medication-and-care-at-home\"> \n <h2>Provide instructions for medication and care at home<\/h2>\n <div class=\"text-content\">\n   This task involves providing the resident and their family with clear instructions for medication administration and care tasks to be performed at home. This includes explaining dosage instructions, potential side effects, and any necessary precautions. By providing clear instructions, we can support the resident and their family in effectively managing their care needs post-discharge. \n <\/div> \n <div class=\"multi-select-content form-field-content\"> \n  <div class=\"form-group\"> <label> Provide instructions for medication and care at home <\/label> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Explain medication dosage instructions \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Discuss potential side effects \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Provide necessary precautions \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Answer any questions or concerns \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"train-family-members-on-residents-care-needs\"> \n <h2>Train family members on resident's care needs<\/h2>\n <div class=\"text-content\">\n   In this task, you will train the resident's family members on the care tasks and interventions that will be needed post-discharge. This includes demonstrating and explaining procedures, such as medication administration or wound care. By training family members, we can ensure that they are equipped with the knowledge and skills to provide appropriate support to the resident at home. \n <\/div> \n <div class=\"multi-select-content form-field-content\"> \n  <div class=\"form-group\"> <label> Train family members on the resident's care needs <\/label> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Demonstrate medication administration \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Explain wound care procedures \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Provide equipment training \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Answer any questions or concerns \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"verify-insurance-coverage-for-discharge-plan\"> \n <h2>Verify insurance coverage for discharge plan<\/h2>\n <div class=\"text-content\">\n   This task involves verifying the resident's insurance coverage to ensure that the proposed discharge plan is covered and financially viable. This includes checking for any restrictions, limitations, or pre-authorization requirements. By verifying insurance coverage, we can avoid any unexpected financial burdens or barriers to accessing necessary resources post-discharge. \n <\/div> \n <div class=\"multi-select-content form-field-content\"> \n  <div class=\"form-group\"> <label> Verify the resident's insurance coverage for the discharge plan <\/label> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Check for coverage restrictions \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Confirm pre-authorization requirements \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Identify any necessary co-pays or out-of-pocket costs \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"review-transportation-needs-for-discharge\"> \n <h2>Review transportation needs for discharge<\/h2>\n <div class=\"text-content\">\n   In this task, you will review the resident's transportation needs for their discharge from the skilled nursing facility. This includes ensuring that transportation arrangements are in place to safely and efficiently transport the resident to their chosen discharge setting. By addressing transportation needs, we can support the resident's successful transition back into the community. \n <\/div> \n <div class=\"multi-choice-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select the transportation needs for discharge <\/label> <select disabled class=\"form-control\"> <option value=\"\">Multiple options can be selected from this list<\/option> <\/select> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Ambulance transport \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Non-emergency medical transportation \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Family or friend pickup \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Other \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section> \n<section id=\"approval-case-manager-review-of-discharge-plan\"> \n <h2>Approval: Case Manager Review of Discharge Plan<\/h2> \n<\/section> \n<section id=\"finalize-and-document-discharge-plan\"> \n <h2>Finalize and document discharge plan<\/h2>\n <div class=\"text-content\">\n   This task involves finalizing and documenting the resident's discharge plan. This includes incorporating all relevant information, instructions, and agreements into a comprehensive discharge plan document. By finalizing and documenting the discharge plan, we can ensure that all stakeholders have a clear understanding of the plan and their respective roles and responsibilities. \n <\/div> \n <div class=\"file-field-content form-field-content\"> \n  <div class=\"form-group\"> <label> Upload the finalized discharge plan document <\/label> \n   <div class=\"file-container\"> <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-upload btn-icon\"><\/i> File will be uploaded here <\/button> \n   <\/div> \n  <\/div> \n <\/div> \n<\/section> \n<section id=\"execute-discharge-plan-on-the-date-of-discharge\"> \n <h2>Execute discharge plan on the date of discharge<\/h2>\n <div class=\"text-content\">\n   In this task, you will execute the resident's discharge plan on the scheduled discharge date. This includes coordinating with all relevant parties, such as transportation services, home health providers, and family members, to ensure a smooth transition. By executing the discharge plan, we can facilitate the resident's successful return to their chosen discharge setting and promote continuity of care. \n <\/div> \n <div class=\"date-field-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select the scheduled discharge date <\/label> \n   <div class=\"date-container\"> <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-calendar btn-icon\"><\/i> Date will be set here <\/button> \n   <\/div> \n  <\/div> \n <\/div> \n <div class=\"members-field-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select the team members involved in executing the discharge plan <\/label> <select disabled class=\"form-control\"> <option value=\"A member or group will be selected here\">A member or group will be selected here<\/option> <\/select> \n  <\/div> \n <\/div> \n <div class=\"send-rich-email-content form-field-content\"> <!-- No Recipients --> <!-- No Recipients --> <!-- No Recipients --> \n  <div class=\"form-group subject\"> <label>Subject<\/label> \n   <p class=\"form-control-static\"> Confirmation of discharge plan execution <\/p> \n  <\/div> \n  <div class=\"form-group body\"> <label>Body<\/label> <iframe srcdoc=\"<p>Dear {{form_Selected_team_members}},<\/p><p>We would like to confirm that the resident's discharge plan has been successfully executed on {{form_Scheduled_discharge_date}}. All necessary arrangements and interventions have been implemented as planned to support the resident's transition back into their chosen discharge setting.<\/p><p>Please feel free to reach out if you have any questions or require further information.<\/p><p>Thank you for your collaboration and dedication to providing quality care.<\/p>\n<style>*{font-family:Inter,&quot;Segoe UI&quot;,&quot;Roboto&quot;,&quot;Oxygen&quot;,&quot;Ubuntu&quot;,&quot;Cantarell&quot;,&quot;Fira Sans&quot;,&quot;Droid Sans&quot;,&quot;Helvetica Neue&quot;,system-ui,sans-serif}<\/style>\n\" sandbox=\"\"><\/iframe> \n  <\/div> \n  <div class=\"form-group\"> <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-envelope btn-icon\"><\/i> Send <\/button> \n  <\/div> \n <\/div> \n <div class=\"multi-choice-content form-field-content\"> \n  <div class=\"form-group\"> <label> Select the outcomes of the discharge plan execution <\/label> <select disabled class=\"form-control\"> <option value=\"\">Multiple options can be selected from this list<\/option> <\/select> \n  <\/div> \n  <ul class=\"items\"> \n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       1 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Successful transition to discharge setting \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       2 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Identification of any issues or concerns \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       3 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Need for post-discharge interventions or adjustments \n    <\/div> <\/li>\n   <li class=\"item\"> \n    <div class=\"step-number-container\"> \n     <div class=\"step-number\">\n       4 \n     <\/div> \n    <\/div> \n    <div class=\"step-checkbox-container\"> \n     <div class=\"step-checkbox\"><\/div> \n    <\/div> \n    <div class=\"item-name-static\">\n      Other \n    <\/div> <\/li> \n  <\/ul> \n <\/div> \n<\/section>\n","protected":false},"excerpt":{"rendered":"<p>Identify resident's discharge goals In this task, you will identify the resident's goals for discharge from the skilled nursing facility. This includes understanding what the resident hopes to achieve, any concerns they may have, and their preferences for aftercare. By understanding the resident's goals, we can tailor the discharge plan to meet their individual needs [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"ep_exclude_from_search":false,"cover_icon_emoji":"\ud83d\udccb","cover_icon_url":"","tasks_count":"20","template_description":"","template_id":"n2heRlNPWdZu9vVwXDpPKQ","task_0":"Identify resident's discharge goals","task_slug_0":"identify-residents-discharge-goals","task_1":"Assess resident's physical health and well-being","task_slug_1":"assess-residents-physical-health-and-wellbeing","task_2":"Review medication regimen","task_slug_2":"review-medication-regimen","task_3":"Consult with interdisciplinary team","task_slug_3":"consult-with-interdisciplinary-team","task_4":"Planning appropriate discharge setting","task_slug_4":"planning-appropriate-discharge-setting","task_5":"Arrange home 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