
AAAASF Cross Reference
MEDICARE OUTPATIENT PHYSICAL THERAPY (OPT) ACCREDITATION STANDARDS MANUAL
Version 3.1, Effective March 1, 2022
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SECTION 5: IN CASE OF EMERGENCY
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​Sub-Section D: Emergency Preparedness Plan
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Disaster Preparedness Policy and Procedure
Emergency Preparedness Box Inventory List
Risk Assessment - 2020
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Sub-Section E: Emergency Preparedness Plan – Integrated Healthcare System
BELIEVE THERAPIES COMPLIANCE DOCUMENTS
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SECTION 11: PERSONNEL
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Sub-Section E: Facility Staffing
BELIEVE THERAPIES COMPLIANCE DOCUMENTS
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Sub-Section J: Vaccination Status
BELIEVE THERAPIES COMPLIANCE DOCUMENTS
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SECTION 15: OUTPATIENT PHYSICAL THERAPY (OPT)
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Sub-Section A: Personnel Qualifications
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Sub-Section B: Compliance with Federal, State, and Local Law
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State Fire Marshall Inspection and Report: 2020
Statement of Discontinuation of Fire Panel Monitoring - Federal Register Vol. 81, No. 86 (see page 26886)
Facility Inspections:
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Annual Fire Extinguisher Inspection Invoice: 2020
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Monthly Fire Extinguisher Inspection Log (sample log - see Maintenance Binder for completed logs)
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Sub-Section C: Administrative Management
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Administrator Letter of Appointment by Managing Members (Original) - 2020, 2022
Alternate Administrator Letter of Appointment by Managing Members (Original) - 2020, 2022
Job Description Acknowledgement Form (Original)
Job Descriptions:
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Administrator - Business Administrator & Clinical Administrator
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Division 1 – Establishment Manager
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Division 2 – Client Services Manager
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Division 3 – Finance Manager
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Division 4 – Therapy Services Manager
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Division 5 – Quality Manager
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Division 6 – Marketing Manager
Additional Hats:
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Senior Therapist
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Client Advocate
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HIPAA Security Officer
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HIPAA Privacy Officer
Business Administrator Performance Review (Original)
Clinical Administrator Performance Review (Original)
Employee Performance Review – Therapy Staff (Original)
Employee Performance Review – Office Staff (Original)
Proof of Purchase of Texas Workforce Postings (Receipt)
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Sub-Section D: Plan of Care and Physician Involvement
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ATTACHMENTS
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Annual Committee Meeting
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Meeting Guidelines​
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Meeting Minutes: 2020 + Attachments / 2021 + Attachments / 2022 + Attachments
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Signed Physician’s Acknowledgement Letter (Dr. David Prier, 2012)
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Emergency Care Procedure (Posting)
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Incident Report Form (Original)
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Incident Report Annual Log (Original)
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Emergency Resource Call List (Posting)
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Sub-Section E: Physical Therapy Services
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Biomedical Inspections - 2021, 2022
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Sub-Section F: Occupational Therapy Services
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**NEW SECTION - POLICY AND PROCEDURE NEEDS TO BE COMPLETED - NOW SPLIT FROM PHYSICAL THERAPY SERVICES (SUB-SECTION E)
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Sub-Section G: Speech Pathology Services
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Sub-Section H: Rehabilitation Program
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Sub-Section I: Arrangements for Services to be Performed By Other Than Salaried Organization Personnel
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Sample of Contract Employee Agreement
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Sub-Section J: Clinical Records
ATTACHMENTS
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Quarterly Committee Meeting
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Meeting Guidelines​
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Meeting Minutes: 2020 (Q1, Q2, Q3, Q4), 2021 (Q1, Q2, Q3, Q4), 2022 (Q1, Q2, Q3, Q4)
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Chart Audit Form (Original)
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Confidentiality Statement (Original)
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Authorization for Request of Protected Health Information (Original)
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Authorization for Disclosure of Protected Health Information (Original)
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Client Request for Amendment to Protected Heath Information (Original)
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Client Intake Paperwork (Original)
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Compliance Plan Mandate (see Federal Register/Vol. 65, No. 194, page 59434)
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Sub-Section K: Physical Environment
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ATTACHMENTS
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Sample Maintenance Log Form (Original)
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Monthly Log for Inspection of the Grounds (Original)
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Bio-hazard Information (Receipt)
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OSHA Form 300 (Original)
**See Maintenance Binder for Working Maintenance Forms**
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Sub-Section L: Infection Control
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COVID-19 Preparedness and Response, Policy and Procedure, and Compliance Audit Form
ATTACHMENTS
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Annual Committee Meeting
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Meeting Guidelines​
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Meeting Minutes: 2020 + Attachments / 2021 + Attachments / 2022 + Attachments
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Cleaning Guides
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Facility Cleaning Logs:
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Documentation of Pest Control​
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Annual Documentation of Completed Services: 2021, 2022
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Wall Postings:
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Consent Form for Blood Borne Pathogens​ (Original)
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Authorization / Declination for Hepatitis B Vaccination (Original)
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Infection Control Monthly Maintenance Log (Original)
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**Completed forms can be found in the Maintenance Binder
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Infectious Disease Annual Log (Original)​
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**Completed forms can be found in the annual meeting minutes attachments​
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Sub-Section M: Program Evaluation
Policy and Procedure
ATTACHMENTS
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Annual Committee Meeting
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Meeting Guidelines​
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Meeting Minutes: 2020 + Attachments / 2021 + Attachments / 2022 + Attachments
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Believe Therapies
521 I-45 Suite 4,
Huntsville, TX 77340
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phone: 936.293.8800
email: info@believetherapies.com
fax: 936.715.3721
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Hours
Monday - Friday
8:00AM - 7:00PM
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Believe Therapies
2305 Longmire Dr Suite 300
College Station, TX 77845
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phone: 936.293.8800
email: info@believetherapies.com
fax: 936.715.3721
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Hours
Monday - Friday
8:00AM - 7:00PM
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