How to do paperwork for obtaining treatment

Fair Use Excerpt of Notes on Speech-language pathology in long term care / Shelly Cordero, Enna D. Santiago, C. Cecile Fountain (1995).  Read more: http://www.copyrightencyclopedia.com/speech-language-pathology-and-audiology-issues-and/#ixzz3e2w5yA8J

Section 1, OBRA and health insurance
Section 2, Screenings

Section 3, Admission Process (pp. 15-18)

3-1 Telephone orders reflect the MD's approval for your intervention/treatment.

3-1-1 Initial Telephone Order - goes to the primary to authorize the eval and  tx.

This is a Repeat symbol for preceding text                                                  

S.T. to evaluate and treat as indicated. 

Speech-Language Pathology to

- Videofluoroscopy swallow to assess for aspiration etiology with increased emphasis upon the pharyngeal phase of swallow, and to determine therapeutic intervention feasibility. Patient is consistently coughing upon drinking liquids.
- Audiology evaluation to rule out otopathology. Patient is requesting frequent repetiions of auditory stimuli in quiet environments.

3-1-2 Clarification orders for S-L P services come after the initial evaluation is completed. Specify the Tx, freq, and duration. Describe modalities, teaching, and training.

- S.T. to treat 5X/week BID X 8 weeks, for oral and pharyngeal stage dysphagia to increase A-P transfer and increase swallow initiation with instruction in safety measures to prevent aspiration.

- ST to treat 5X/week QD X 6 weeks to increase word finding skills accompanied by semantically correct verbal output secondary to recent CVA.

- S.T. to treat 5X/week QD X 4 weeks secondary to a decline in cognitive-linguistics skills related to decreased spatial, temporal orientation and decreased short term memory.

3-1-3 Change of treatment? Document in your progress notes and get new telephone orders from Physician. 

3-1-3-1 ΔDuration Extend S.T. treatments 5X/week QD for 4 weeks as patient has not met maximum potential in ability to follow 2-step directions and answer yes/no questions.

3-1-3-2 ΔModality : Use a telephone order to add modalities or discontinue

- S.T. to change liquid level from "honey" thickened to "nectar" thickened liquids secondary to increased timeliness of swallow.

- S.T. to upgrade food texture from mechanical soft to regular diet secondary to increased ability to masticate in a rotary manner.

- S.T. to add modality of dysphagia treatment to existing cognitive-linguistic treatment, secondary to recent declines in chewing, swallowing abilities.

3-1-3-3 ΔFrequency
- S.T. to decrease treatments from 5X/week BID to 5X/week QD for pharyngeal stage dysphagia treatment.
- S.T. to decrease treatments from X to Y for 2 weeks in preparation for D/C planning. S.T. to continue to address A with emphasis on safety awareness, patient/staff education/training to continue to follow through with techniques taught.
- S.T. to increase treatments from X to Y for N weeks secondary to increased alertness and endurance for J.

3-1-3-4 Transferring from Part A to B of Medicare (after 100 days)
Get a telephone order.
- Pt to continue S.T tx 5X/week QD X4 weeks for the modality of aphasia.
- Pt to continue s.T. tx 5X/week QD X2 weeks. S.T. to increase word finding skills, accompanied by semantically correct verbal output and to provide pt/caregiver training, secondary to recent CVA.

3-1-3-5 DONE! Get telephone order auth from MD for any discontinuation of services. To prevent decline, refer residents of SNFs to "restorative nursing" and/or Activities or Social Services.
- S.T. to discharge pt from Aphasia tx. Restorative nursing to continue conversation with resident related to basic wants and needs.
- S.T. to discharge pt from services. Pt has met max potential of functioning. D/C to restorative nursing to monitor compensatory strategies for safe eating.
- Discontinue S.T. services. Restorative nursing to continue with positioning strategies for eating, and dysphagia techniques taught.
-  Discontinue S.T. services. Restorative nursing to continue with facilitating the use of basic language expression through the use of an alternative communication system.