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Tools And Resources
Tools And Resources
Admission Transfer Discharge Rights
Discharge Needs Assessment
Discharge Summary
NYS SAMPLE DISCHARGE NOTICE TEMPLATE – 2025
Emergency Preparedness
11.13.24 Sample PP – Influenza Vaccine Staff Rev 11.13.2024
COVID-19-Healthcare-ETS-502-Employee-Training
COVID-19_Healthcare_ETS_Model_Written_Plan
PP-Vendors-during-Pandemic-1
PP-Telehealth-During-Pandemic-1
PP-Subsistence-Policy-1
PP-Resident-Screening-1
PP-Regulated-Medical-Waste-biohazard-1
PEP_Tool_Kit_Annex_K_final-8-20-2020-5
2.20.24 Sample PP – Infection Control and Prevention Program Rev 2.20.2024
Accessing-PEP-plan-files-on-HC
PEP_Tool_Kit_Annex_K_final-8-20-2020-5
CEMP_and_PEP_Template_revised-8-20-2020-final
11.19.21 Sample PP – STRIKE PLAN
Facility Assessment
Prospective employee hire log & retention
hva_template
GNYHCFA Facility Assessment 8.21.2024
7.16.24 Sample PP – Facility Assessment
General Policies & Procedures
LESSON-PLAN-Sample-Trauma-Informed-Care-F699-1 QAPI-Policy-and-Procedure-1
LESSON-PLAN-Sample-Nursing-Care-Giver-Hours-1
Facility-Assessment-IG-2
9.2022-CMS-Phase-3-Requirements-of-Participation-Checklist-GNYHCFA-1
9.29.22-Sample-PP-Search-of-Resident-Property-Packages_-1
9.20.22-Sample-PP-Disposal-of-Fentanyl-patches-1
9.16.22 Sample PP – Resident Self Determination Intimate Relationships
1.30.23 Sample PP – Resident Care Planning
2.7.24 Sample PP – Employee Health and Physical
10.10.24 Sample PP- Infection Control and Prevention Program 10.10.2024
9.10.25 Sample PP – Covid-19 Vaccine for Residents Rev 9.10.2025
SAMPLE PP BedHold 2020
Dementia Care Compentency
Sample PP – Resident with Dementia
Bed System Measurement Device Test Results Worksheet
6.10.21 Personal and Compassionate Caregivers Elective Form
6.10.21 Personal and Compassionate Cargiving Visitation Fact Sheet
6.10.21 Sample PP – Personal and Compassionate Caregiving Visitation in NHs
SAMPLE QAPI STATEMENT AND ACTION PLAN
LS3-QAPIPlanHow-To-Guide (1)
QAPIPlanHow-To-Guide
QAPI MADE EASY sample
QAPI FORM
3.7.22 Sample PP – Medication Adminstration Guidance for Thickened Liquids
3.7.22 Sample PP – Thickening Liquids
4.26.22 Sample PP – Out on Pass Rev 4-26-2022
9.15.22-Sample-PP-Search-of-Resident-Property-Packages-1
9.15.22-Sample-Package-Log-1
9.13.22-CMS-Phase-3-Requirements-of-Participation-Checklist-GNYHCFA
9.12.22-Sample-PP-QAA-Committee-9.5.2022-1
9.12.22-Sample-PP-Opioid-Usage-1
9.8.22-Sample-PP-Visitation-Rev-9.8.2022-1
9.5.22-Sample-PP-Non-Smoking-9.5.2022-1
4.13.22-SAMPLE-Comprehensive-Care-Plan-Policy-1-1 (1)
F812 – 5. GNY SERVICE AND DISTRIBUTION
F812 – 3. GNY STORAGE
F812 – 1. GNY PHYSICAL BIOLOGIC CHEM PEST CONTAMINATION
10.24.22 Sample PP-Side Rail Usage revised 10 24 22
10.31.22 Sample PP – Physical Restraint rev 10 31 22
11.7.22 Sample – FIR -Five Day Report
11.8.22 Sample PP- Psychosocial Well Being Guide
12.27.22 Sample PP – NOMNC
1.10.23 Sample PP – Anaphylaxis
1.30.23 Sample PP – Resident Care Planning
2.6.23 Sample PP -Resident Expiration
5.9.23 Sample PP – Dining 5.9.2023
6.8.23 Sample Lesson Plan – Change in Condition
7.6.23 Sample PP F582
12.20.23 Sample PP – Home Like Environment
12.21.23 Sample PP – Required Postings
1.19.24 Sample PP – Grievances 1.19.2024 rev
2.7.24 Sample Employee-Health-Annual-Assessment
3.20.24 Sample PP – Advanced Directives 3.20.2024
4.17.24 Sample PP – CHRC updated 2024
9.4.24 Sample PP – Medication Reconciliation Nursing
9.4.24 Medication Reconciliation Checklist and Progress Note Template
10.2024 Sample PP – LGBTQIA
11.1.24 Sample Lesson Plan – LGBTQIA with Post Test 11.1.2024
12.4.24 Sample PP – Accident Incident Investigation and Reporting 12.4.2024
2.19.25 Sample PP – PASRR Rev 2.13.2025
2.19.25 Sample PP – MDS Accuracy of Assessments
2.19.25 Sample PP – Staffing Rev. 1.23.2025
2.19.25 Sample PP – Medical Director – Roles and Responsibilities 12.5.2024
2.19.25 Sample PP – Discharge Planning 12.12.2024 (002)
2.19.25 Sample PP – Chemical Restraints 12.11.2024
2.19.25 Sample PP – Change in Condition Rev 2.19.2025
2.19.25 – CMS Surveyor Guidance Checklist – CMS Updates Effective 3.24.2025 Rev 2.19.2025
2.26.25 Sample PP – Controlled Substances
2.26.25 Sample PP – Medication Administration
3.21.25 Sample PP – Pain Management
3.21.25 Sample PP – QAPI 12.4.2024
6.4.25 Sample PP – Foley Catheter Insertion, Removal and Maintenance Rev
7.30.25 Sample PP – Pneumococcal Immunizations Rev 7.30.2025
Infection Control (including PP's)
9.10.25 Sample PP – Covid-19 Vaccine for Residents Rev 9.10.2025
SBAR_UTI
Sample Antibiogram
DOHMH Infection Control Resource for Long-Term Care
PPE Guidance: Gloves
PPE Guidance: Gowns
9.13.22 Sample PP – Guidelines for IV Catheters 9 13 22
7.14.21 Sample PP – Cleaning and Disinfecting Environmental Surfaces
2.18.21-SAMPLE-PP-Influenza-Vaccine-Residents
11.3.21-Sample-Contact-Tracing-Residents
11.3.21-Sample-Contact-Tracing-Staff
3.2.22 Sample PP – Linen Management
4.26.22 Sample PP Legionella Policy incl audits
3.10.22 Sample PP – Tuberculosis
9.2.22 Sample PP – Monkeypox 9 2 22
1.13.23 Sample Lesson Plan Influenza
4.27.23 Sample PP – Candida Auris
5.25.23 Sample PP – Cleaning and Disinfection of Shared Equipment5.25.2023
9.27.23 Sample Consent Form Covid Vaccine Staff – GNYHCFA
9.27.23 Sample Consent Form Covid Vaccine Residents – GNYHCFA
1.10.23 Sample PP – Influenza Prevention and Management
1.29.24 – Visitor Fact Sheet revised_
2.14.24 Sample PP – Infection Preventionist 2.14.2024
2.20.24 Sample PP – Cohorting Plan During Covid Rev 2.20.2024
4.2.24 Sample PP – Hepatitis C Screening 4.2.2024
5.1.24 Sample PP – Enhanced Barrier Precautions – Updated Links
5.2.24 Enhanced Barrier Precautions – Facility Assessment rev
Tool – Enhanced Barrier Precautions
Signage – Stay Home If Sick
Signage – Handwashing
Signage – Handwashing Germs All Around You
Signage – Droplet Precautions
Signage – Contact Precautions
Infection Line List
Checklist – 2023
2.20.24 Sample PP – Cohorting Plan During Covid Rev 2.20.2024
7.25.24 Sample PP – Antibiotic Stewardship
7.25.24 QAPI – Antibiotic Stewardship
Consent doh-4156 (1)
EUA Fact Sheet Pfizer Covid Vaccine 2024-2025
EUA Fact Sheet Novavax Covid Vaccine 2024-2025
EUA Fact Sheet Moderna Covid Vaccine 2024-2025
11.13.24 Sample PP – Influenza Vaccine Staff Rev 11.13.2024
1.10.25 Sample PP – Norovirus
4.25.25 Sample PP – Preventing Respiratory Infection in Residents Using Respiratory Therapy Equipment
5.30.25 Poster – We Offer Vaccines
9.10.25 Sample PP – Comprehensive Covid Rev 9.10.2025
9.10.25 Sample PP – Covid 19 Vaccine for Staff Rev 9.10.2025
9.11.25 Sample PP – Respiratory Syncytial Virus 9.11.2025
PDPM Medicare Resources / Checklist
TCG PROPOSED PDPM Rate DRAFT NY Boroughs
TCG PROPOSED PDPM Rate DRAFT Nassau and Suffolk
HANDOUT #5 SAMPLE PHYSICIAN DIAGNOSIS QUERY TEMPLATES
Handout #4 TCG PDPM Medicare Diagnosis Worksheet
HANDOUT #3 AANAC PDPM TOOLS
HANDOUT #2 DAILY SKILLED NURSE’S NOTE FORM
HANDOUT #1 SNF DOCUMENTATION GUIDELINES
PRESENTATION #5 GNYHCA MANAGING THE MEDICARE RESIDENT
PRESENTATION #4 GNYHCFA PUTTING IT ALL TOGETHER PDPM CASE STUDY
PRESENTATION #3 GNYHCFA ICD-10-CM AND UB-04 CODING FOR PDPM
PRESENTATION #2 GNYHCFA UNDERSTANDING PDPM; COMPONENTS & MDS CODING FOR PDPM
PRESENTATION #1 GNYHCFA OVERVIEW HEALTH CARE LANDSCAPE MEDICARE 101 SNF DOCUMENTATION
2024 Updated TCG CHECKLIST FOR CLAIMS AUDITS
PDPM Medicare Resources / Checklist
TCG PROPOSED PDPM Rate DRAFT NY Boroughs
TCG PROPOSED PDPM Rate DRAFT Nassau and Suffolk
HANDOUT #5 SAMPLE PHYSICIAN DIAGNOSIS QUERY TEMPLATES
Handout #4 TCG PDPM Medicare Diagnosis Worksheet
HANDOUT #3 AANAC PDPM TOOLS
HANDOUT #2 DAILY SKILLED NURSE’S NOTE FORM
HANDOUT #1 SNF DOCUMENTATION GUIDELINES
PRESENTATION #5 GNYHCA MANAGING THE MEDICARE RESIDENT
PRESENTATION #4 GNYHCFA PUTTING IT ALL TOGETHER PDPM CASE STUDY
PRESENTATION #3 GNYHCFA ICD-10-CM AND UB-04 CODING FOR PDPM
PRESENTATION #2 GNYHCFA UNDERSTANDING PDPM; COMPONENTS & MDS CODING FOR PDPM
PRESENTATION #1 GNYHCFA OVERVIEW HEALTH CARE LANDSCAPE MEDICARE 101 SNF DOCUMENTATION
2024 Updated TCG CHECKLIST FOR CLAIMS AUDITS
Regulatory Guidance
GW-Sample SNF Investigations Log
CMS Requirements of Participation for Long Term Care Dental Services
Fire Watch Log
Temporary Fire Watch Plan
Fire Watch Procedures
Winter Weather Preparedness
Generator Testing
Applicable to NYC Facilities Only: 6.11.24 – NYC FACILITIES MP102 parapet inspection
F Tags 4.28.2025
Behavioral Health
TOOLKIT – Substance Use Disorder Treatment
TOOLKIT – NH Naloxone PP Toolkit 3.1.2023
COE Understanding Hoarding in the Nursing Facility
COE – Facility Assessment Approach to Behavioral Health
COE – Overview of Schizophrenia and Psychosis
COE Admissions Review of Nursing Home Residents with a Methadone Order
COE Behavioral Health Needs Assessment with examples
COE De-Escalation Strategies
COE Tips to Support a Resident with Schizophrenia
COE Ways NHs Can Promote Substane Use Recovery