Appendix E. VNSNY Workflow Diagrams for Pilot Testing e-transitions

Development of Electronic Transition Tools for Home Health Care

Referral via e-transitions Web site 

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Intake by Visiting Nurse and Signing of CMS-485

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Intake by Visiting Nurse and Signing of CMS-485 (continued)

Notes:
*Text in bold/red refer to tasks that need to be performed either by RN on tablet or by MD with hard copy of e-485.
**If pilot MD says another MD must approve part of POC (e.g., medication and dose), usual procedure for processing modifier to cover orders not signed by primary physician will be followed. VN will notify Research Center and Research Center will update e-transitions database when approval (verbal or signed e-485) is received.

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Intake by Visiting Nurse and Signing of CMS-485 (continued)

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Exchange of Information between Visiting Nurse and Primary Physician during Episode of Care

[D] Select for Text Description.

Exchange of Information between Visiting Nurse and Primary Physician during Episode of Care (continued)

[D] Select for Text Description.