22-105684-Service and Operating Policy- 12-14-220F,A
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CATHOLIC COMMUNITY SERVICES
SECTION I GUIDING PRINCIPLES
1.0 INTRODUCTION FROM THE CLINICAL OVERSIGHT GROUP (COG)
2.0 CCS VISION, MISSION, BELIEF STATEMENT, & CORE VALUES
3.0 THE VALUE AND DIGNITY OF HUMAN LIFE
4.0 AGENCY SERVICE PHILOSOPHY
5.0 CODE OF ETHICS
6.0 CCS IS A FAITH -BASED ORGANIZATION
SECTION II QUALITY IMPROVEMENT
7.0 QUALITY IMPROVEMENT
7.1 Local Quality Improvement Committee
7.2 CCSWW Quality Improvement Committee
7.3 Clinical Oversight Group (COG)
8.0 OTHER POLICIES AND PROGRAM MANUALS
SECTION III STAFF AND VOLUNTEER POLICIES
9.0 WASHINGTON STATE PATROL/DSHS BACKGROUND CHECKS
9.1 Procedure
10.0 LEGAL REPRESENTATION
10.1 Legal Representation of Staff
10.2 Legal Representation of the Agency
10.3 CCS Providing Expert Witness Testimony
11.0 STAFFPRESSINGCHARGESAGAINSTCLIENTS
12.0 WHISTLE BLOWER PROTECTIONS
13.0 FAVORITISM IN USE OF AGENCY SERVICES
14.0 PAYMENT FOR REFERRALS
15.0 CONFLICT OF INTEREST
15.1 Prohibition Against CCS Employees Providing CCS Foster Care
16.0 SECONDARY EMPLOYMENT FOR EMPLOYEES WITH A PRIVATE PRACTICE
17.0 GIFT CARD POLICY
18.0 VOLUNTEER STATEMENT
SECTION IV SERVICES
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CATHODIC COMMUNITY SERVICES
SERVING PEOPLE OF ALL BELIEFS
CCSWW SERVICE POLICIES & PROCEDURES
REVISION W.
Revised January 4, 2021
CATHOLIC COMMUNITY SERVICES
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19.0 ACCESS TO SERVICES
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20.0 CLIENT RIGHTS
20.1 Client Rights and Confidentiality
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21.0 (Part A) CONSENT TO SERVICES FOR REGULAR/NON-HIPAA SERVICE AREAS
21.1(Part A) Use of Consent to Services (Regular/Non-HIPAA) Form
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21.2 (Part A) Exceptions to use of Consent to Services (Regular/Non-HIPAA) Form in Regular Service Areas 11
21.3 (Part A) Consent to Services (Regular/Non-HIPAA) Form Elements
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21.0 (Part B) CONSENT TO SERVICES FOR HIPAA-COVERED SERVICE AREAS
21.1(Part B) Use of Consent to Services (HIPAA) Form
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21.2 (Part B) Consent to Services (HIPAA) Form Elements
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22.0 (Part A) SHARING CLIENT INFORMATION WITH OTHERS IN REGULAR/NON-HIPAA SERVICE AREAS
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22.1(PartA) Information Sharing by Regular/Non-HIPAA Covered Services in CCS
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22.2 (Part A) Transfer of CCS Client Information across Discrete CCS Records
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22.0 (Part B) SHARING CLIENT INFORMATION WITH OTHERS IN HIPAA-COVERED SERVICE AREAS
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22.1(Part B) Information Sharing by CCS HIPAA-covered Service Areas
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22.2 (Part B) Transfer of CCS Client Information across Discrete CCS Records
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23.0 CCS 1S A HIPAA HYBRID ORGANIZATION
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23.1 How is Confidentiality Different in CCS Service Areas that are Covered by HIPAA and CCS Service Areas
that are NOT Covered by HIPAA?
23.2 Notice of Privacy Practices for Service Areas Covered by HIPAA
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23.3 Breach Notification for Information Protected under HIPAA in Covered Entity Service Areas
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23.4 Breach Notification in Regular CCS Service Areas (Not Covered by HIPAA)
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23.5 Documentation of Unauthorized Disclosures (HIPAA)
23.6 Client Request of Accounting for Unauthorized Disclosures of Protected Health Information (HIPAA)
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23.7 Purchasing of Outside Services by CCS HIPAA-covered Entity Service Areas
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23.8 Annual HIPAA Compliance Checklist
23.9 Annual Confidentiality Checklist
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23.10 Additional Information Regarding State and Federal Requirements Regarding Confidentiality
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24.0 OBTAINING AUTHORIZATION TO USE AND DISCLOSE INFORMATION AND EXCEPTIONS TO
CONFIDENTIALITY
24.1 Use of Authorization to Use and Disclose Health/Service Information (AFD)
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24.2 Who is Allowed to Sign the Authorization to Use and Disclose Health/Service Information (AFD) Form?24
24.3 Consent for Audio and Video Recording
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CATHOLIC COMMUNITY SERVICES
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24.4 Confidentiality Agreement with Professional and Vendor Associates 25
24.5 Subpoenas and Court Orders 25
24.6 Mandated Reporting of Abuse and/or Neglect 25
24.7 CPS (Child Protective Services) and APS (Adult Protective Services) Reporting by Attorneys who Work in
CCS Service Areas 25
24.8 Warning Potential Victims of Threat of Physical Harm 26
25.0 HOW TO TELL WHICH CONFIDENTIALITY FORM TO USE
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26.0 DENIAL OF SERVICES
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27.0 QUALITY MONITORING OF PURCHASED SOCIAL OR HUMAN SERVICES FROM OTHER AGENCIES,
ORGANIZATIONS, AND/OR PRIVATE PROVIDERS
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28.0 FEES
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29.0 GIFT CARDS
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30.0 PROHIBITION OF CORPORAL PUNISHMENT/PHYSICAL DISCIPLINE AND AVERSIVE PROCEDURES
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31.0 PROVISION OF SERVICES TO PEOPLE WITH SEXUAL OFFENSE HISTORIES
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32.0 PRESERVING GOOD BOUNDARIES WITH CLIENTS
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33.0 INCIDENT REPORTING
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34.0 INVESTIGATION PROTOCOL
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34.1 Investigation Policy and Procedure
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34.2 Choice of Investigator
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34.3 Timeline of the Investigation
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34.4 Steps of the Investigation
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34.5 Review of Results and Disposition of the Charges
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35.0 CLIENT COMPLAINTS 36
35.1 Informal Complaint/Problem Resolution 36
35.2 Formal Complaint Resolution 36
35.3 Formal Complaint Procedure 36
36.0 TEXT MESSAGING 37
36.1 Destruction of Text Messages 38
37.0 WEAPONS STORAGE POLICY FOR CCS SHELTERS AND DAY CENTERS 38
37.1 Weapons Storage Protocol for Facility Based Shelters and Day Centers in Facilities Owned or Leased by
CCS 38
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19.0 ACCESS TO SERVICES
20.0 CLIENT RIGHTS
20.1 Client Rights and Confidentiality
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21.0 (Part A) CONSENT TO SERVICES FOR REGULAR/NON-HIPAA SERVICE AREAS 10
21.1(Part A) Use of Consent to Services (Regular/Non-HIPAA) Form 11
21.2 (Part A) Exceptions to use of Consent to Services (Regular/Non-HIPAA) Form in Regular Service Areas 11
21.3 (Part A) Consent to Services (Regular/Non-HIPAA) Form Elements 12
21.0 (Part B) CONSENT TO SERVICES FOR HIPAA-COVERED SERVICE AREAS 12
21.1(Part B) Use of Consent to Services (HIPAA) Form 12
21.2 (Part B) Consent to Services (HIPAA) Form Elements 13
22.0 (Part A) SHARING CLIENT INFORMATION WITH OTHERS IN REGULAR/NON-HIPAA SERVICE AREAS 13
22.1(Part A) Information Sharing by Regular/Non-HIPAA Covered Services in CCS 14
22.2 (Part A) Transfer of CCS Client Information across Discrete CCS Records 15
22.0 (Part B) SHARING CLIENT INFORMATION WITII OTIICRS IN HIPAA-COVERED SERVICE AREAS 15
22.1(Part B) Information Sharing by CCS HIPAA-covered Service Areas 15
22.2 (Part B) Transfer of CCS Client Information across Discrete CCS Records 16
23.0 CCS IS A HIPAA HYBRID ORGANIZATION 17
23.1 How is Confidentiality Different in CCS Service Areas that are Covered by HIPAA and CCS Service Areas
that are NOT Covered by HIPAA? 17
23.2 Notice of Privacy Practices for Service Areas Covered by HIPAA 18
23.3 Breach Notification for Information Protected under HIPAA in Covered Entity Service Areas 18
23.4 Breach Notification in Regular CCS Service Areas (Not Covered by HIPAA) 19
23.5 Documentation of Unauthorized Disclosures (HIPAA) 21
23.6 Client Request of Accounting for Unauthorized Disclosures of Protected Health Information (HIPAA) 21
23.7 Purchasing of Outside Services by CCS HIPAA-covered Entity Service Areas 21
23.8 Annual HIPAA Compliance Checklist 22
23.9 Annual Confidentiality Checklist 22
23.10 Additional Information Regarding State and Federal Requirements Regarding Confidentiality 23
24.0 OBTAINING AUTHORIZATION TO USE AND DISCLOSE INFORMATION AND EXCEPTIONS TO
CONFIDENTIALITY 23
24.1 Use of Authorization to Use and Disclose Health/Service Information (AFD) 23
24.2 Who is Allowed to Sign the Authorization to Use and Disclose Health/Service Information (AFD) Form? 24
24.3 Consent for Audio and Video Recording 24
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37.2 Weapons Storage Policy for Community Based Shelters/Day Centers Hosted by Outside Groups 39
37.3 Weapons Disposal 39
38.0 RESPONDING TO LAW ENFORCEMENT OFFICIALS
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38.1 Guidelines for Immediately Responding to Law Enforcement Officials 40
38.2 Guidelines for Immediately Responding to Law Enforcement Officials in Drug/Alcohol Treatment
Locations
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38.3 How to Interact with Bail Bondsmen
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39.0 Interactions with Immigration Agencies
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39.1 Procedures Regarding Access to CCS/CHS Facilities/Buildings
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39.2 Procedures Regarding Immigration Agents' Request for Access to CCS/CHS Records/Files:
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39.3 Procedures Regarding Immigration Agents' Request For Access to CCS/CHS 1-9 Forms
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SAMPLE JUDICIAL WARRANT
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40.0 Research Statement
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SECTION V MEDICATION
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41.0 PRESCRIPTION PADS
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41.1 CCS Prescription Drug Pads
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41.2 Non-CCS Prescription Drug Pads
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41.3 Quality Improvement
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42.0 Medication Samples
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43.0 MEDICATION ACCESS/STORAGE/PROMPTING POLICY FOR SHELTER AND HOUSING
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44.0 NALOXONE USE
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45.0 USE OF OTHER MEDICATIONS
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46.0 ADVANCE DIRECTIVES
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47.0 PEER REVIEW FOR PRESCRIBING OF MEDICATIONS
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SECTION VI RECORDS
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48.0 CREATING SERVICE RECORDS
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48.1 General Procedure
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48.2 Record Content
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49.0 RECORD SECURITY, QI REVIEW, AND RECORD STORAGE
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49.1 General Record Security
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49.2 Records Review
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49.2.1 Procedure for Records Review
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49.3 Secure Storage of Service Records 56
50.0 (Part A) HANDLING CLIENT REQUESTS FOR SERVICE RECORDS IN REGULAR/NON-HIPAA SERVICE AREAS 56
50.1(Part A) Client Requests for Access to their Service Records — General Information 56
50.2 (Part A) What the Client or Legally Authorized Representative May Access from the Record 57
50.3 (Part A) Requests for Records of Deceased Persons 57
50.0 (Part B) HANDLING CLIENT REQUESTS FOR SERVICE RECORDS IN HIPAA-COVERED SERVICE AREAS 57
50.1(Part B) Client Requests for Access to their Service Records —General Information 57
50.2 (Part B) What the Client or Legally Authorized Representative May Access from the Record 58
50.3 (Part B) Requests for Records of Deceased Persons 59
51.0 Destruction of Archived Records
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SECTION VII TITLE VI PLANS
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52.0 TITLE VI PLANS FOR VOLUNTEER TRANSPORTATION PROGRAMS
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SECTION VIII FORMS
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ANNUAL CONFIDENTIALITY CHECKLIST (Regular/Non-HIPAA)
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ANNUAL HIPAA COMPLIANCE CHECKLIST SCORECARD — CCSWW CE Programs
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AUTHORIZATION FOR ELECTRONIC COMMUNICATION
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CCS AUTHORIZATION TO USE AND DISCLOSE HEALTH/SERVICE INFORMATION (AFD)
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BUSINESS ASSOCIATE / QUALIFIED SERVICE ORGANIZATION AGREEMENT
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CLIENT RELEASE FOR MEDICATION PROMPTING SERVICE
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CONSENTTO SERVICES (Regular/Non-HIPAA Covered Services)
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CONSENTTO SERVICES (HIPAA-Covered Services)
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CONFIDENTIAL DATA LOSS INVESTIGATION FORM (NON-HIPAA SERVICE AREA)
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CONSENT FOR AUDIO AND/OR VIDEO RECORDINGS OF THERAPEUTIC SESSIONS
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DISCLOSURE LOG FOR UNAUTHORIZED RELEASE OF PROTECTED HEALTH INFORMATION
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DUTY TO WARN ASSESSMENT & PLANNING
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FORMAL COMPLAINT FORM
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HIPAA BREACH INVESTIGATION FORM
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IMAGE & INFORMATION CONSENT FORM FOR STAFF, VOLUNTEERS, AND CLIENTS
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INCIDENT REPORT
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INDEPENDENT CONTRACTOR AGREEMENT FOR HEALTH CARE PROVIDERS
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LOCAL QUALITY IMPROVEMENT COMMITTEE ANNUAL PLAN
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LOCAL QUALITY IMPROVEMENT QUARTERLY MEETING/ACTIVITY REPORT
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MEDICATION DISPOSAL FORM
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MEDICATION LOG FOR SHELTER AND HOUSING
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CATHOLIC COMMUNITY SERVICES
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37.2 Weapons Storage Policy for Community Based Shelters/Day Centers Hosted by Outside Groups 39
37.3 Weapons Disposal 39
38.0 RESPONDING TO LAW ENFORCEMENT OFFICIALS 40
38.1 Guidelines for Immediately Responding to Law Enforcement Officials 40
38.2 Guidelines for Immediately Responding to Law Enforcement Officials in Drug/Alcohol Treatment
Locations 41
38.3 How to Interact with Bail Bondsmen 42
39.0 Interactions with Immigration Agencies 42
39.1 Procedures Regarding Access to CCS/CHS Facilities/Buildings 42
39.2 Procedures Regarding Immigration Agents' Request for Access to CCS/CHS Records/Files: 44
39.3 Procedures Regarding Immigration Agents' Request For Access to CCS/CHS 1-9 Forms 45
SAMPLE JUDICIAL WARRANT 46
40.0 Research Statement 46
SECTION V MEDICATION 47
41.0 PRESCRIPTION PADS 47
41.1 CCS Prescription Drug Pads 47
41.2 Non-CCS Prescription Drug Pads 47
41.3 Quality Improvement 47
42.0 Medication Samples 47
43.0 MEDICATION ACCESS/STORAGE/PROMPTING POLICY FOR SHELTER AND HOUSING 48
44.0 NALOXONE USE 51
45.0 USE OF OTHER MEDICATIONS 53
46.0 ADVANCE DIRECTIVES 53
47.0 PEER REVIEW FOR PRESCRIBING OF MEDICATIONS 53
SECTION VI RECORDS 54
48.0 CREATING SERVICE RECORDS 54
48.1 General Procedure 54
48.2 Record Content 55
49.0 RECORD SECURITY, QI REVIEW, AND RECORD STORAGE 55
49.1 General Record Security 55
49.2 Records Review 55
49.2.1 Procedure for Records Review 56
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CATHOLIC COMMUNITY SERVICES
SERVING PEOPLE OF ALL EELIEES
NALOXONE DISTRIBUTION PLAN
NOTICE OF PRIVACY PRACTICES (NPP)
NOTIFICATION OF BREACH OF UNSECURED PHI
QUARTERLY RISK MANAGEMENT REPORT
INTERNAL REQUEST FOR REVIEW OF INDEPENDENT CONTRACTOR RELATIONSHIP
SAMPLE MEDICATION DISTRIBUTION LOG
SAMPLE MEDICATION INVENTORY LOG
SIGNATURE AUTHENTICATION FORM
SYSTEM -WIDE QUARTERLY QUALITY IMPROVEMENT SCORECARD
TITLE VI PLAN FOR THE FEDERAL TRANSIT ADMINISTRATION AND WASHINGTON STATE DEPARTMENT01
TRANSPORTATION
VENDOR CONFIDENTIALITY AGREEMENT
WEAPONS STORAGE LOG SHEET
WEAPONS TAG - SAMPLE
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