New Patient Setup Checklist

Care Airways Corporation 1095 Broken Sound Parkway NW Suite 101 Boca Raton, FL 33487

Phone : 855.713.1012 Fax : 561.634.3424

NEW PATIENT SETUP CHECKLIST

Confirm Delivery Date/Proof of Delivery
Review Client Rights and Responsibilities (In new patient startup packet)
Review Normal Business Hours, After hours and contact information
Review Payor required Documents. (separate checklist)
Review and Confirm Receipt of National Supplier Standards
Patients role in participation of plan of service.
Option for rental and purchase of equipment
Proper Set up and use of the equipment in compliance with physicians orders
Review Quick Start guide and Owners Manual
Review Infection control issues, safety risks and potential hazards (i.e. no smoking)
Review Residence safety and safety considerations
Handling of emergencies, how to contact, emergency preparedness
Device maintenance, cleaning, troubleshooting, potential hazards.
Process for reporting injuries while using the equipment.
Complaint process
Document Emergency Contact in patient record.
Log and Label Recorded Call.
After Setup, Checklist emailed to patient for return signature.
Advise customer of SPECIAL NEEDS REGISTRY

 

Patient Setup Date:

Patient Name:

Patient Phone number:

Patient Email address:

Your e-Signature

Clear Signature

Date: