Entering Demographics

Enter the social security number, if known.

Enter the date of birth in mm/dd/yyyy format.

Click the arrow beside this field and select Female or Male.

Click the arrow beside this field and select from the pre-defined ethnicity options.

Enter the patient's height in the ft. and inches fields.

Enter the patient's height in the ft. and inches fields.

Click the Blood Type drop-down field and select the correct blood type for the selected patient (i.e. A+, A-, AB+, AB-, B+, B-, O+, O-).

Click the arrow beside this field and select from the pre-defined disaster codes.

If you did not enter a location on the Address/Phones tab, click the arrow beside Current Location and select the type of location for the patient's address (such as Home, Assisted Living Facility, and so on).

Click the arrow beside this field and select from the pre-defined list of living status.

Click the arrow beside this field and select from the pre-defined list of marital status.

Click the arrow beside this field and select from the pre-defined list of employment status.

Click the arrow beside this field and select from the pre-defined list of religions.

Click the arrow beside this field and select from the pre-defined list of languages.

If the patient is a veteran, click this check box to meet CMS hospice CAHPS requirements.

If you are readmitting the patient to the same home health agency, click this check box.

If you are transferring the patient from another home health agency, click this check box. If you select this check box, you must enter a date in the Other Agency Episode Begin Date field.

Enter specific directions to the patient's home.

Note any safety precautions in this field (Protective dog, broken glass on ground, and so on).

Enter any additional notes.