Forms
2024-2025 Payment Schedule
Staff Payment Schedule (Updated Annually)
Weekly Signature Page
Weekly Signature Page is used to have patient/consumer or authorized family member sign visits performed.
Nursing Progress Note
We process our progress notes in Kinnser. The attached nursing progress note is to be used by RN's and LPN's that need a form to document during the visit however the note will need to be finalized in Kinnser. in addition, these progress notes are available in cases where the EVV (electronica Visit Verification) system is down or in emergency cases where you do not have access to EVV system. Iconnect clock in and out EVV system is required by APD Medicaid. Training will be provided within the first 7-14 days of beginning services.
HHA PS Progress Note & Weekly
HHA Personal Support Progress Note & signature page to be filled out on a weekly basis These progress notes are available in cases where the EVV (electronica Visit Verification) system is down or in emergency cases where you do not have access to EVV system. Iconnect clock in and out EVV system is required by APD Medicaid. Training will be provided within the first 7-14 days of beginning services.
HHA Life Skill (Companion) Note & Weekly
HHA Life Skill Companion Progress Note & signature page to be filled out on a weekly basis These progress notes are available in cases where the EVV (electronica Visit Verification) system is down or in emergency cases where you do not have access to EVV system. Iconnect clock in and out EVV system is required by APD Medicaid. Training will be provided within the first 7-14 days of beginning services.
RN Staff Application
Application to be filled out by RN's. If you prefer to apply online, copy and paste this link to a separate browser: https://pdf.ac/2o7SdF
LPN Staff Application
Application to be filled out by LPN's.If you prefer to apply online, copy and paste this link to a separate browser: https://pdf.ac/2o7SdF
Home Health Aide Staff Application
Application to be filled out by HHA's or CNA's. If you prefer to apply online, copy and paste this link to a separate browser: https://pdf.ac/47DP9D
Instruction for Electronic Visit Verification
Instructions for clocking in and out of Cyberark Identity App