As a health care provider or medical facility, it is important to have efficient communication and collaboration between you, your staff and other healthcare team members in order to deliver quality patient care. In this blog post, we will discuss the importance of physician delegation forms. We'll explore what they are, why they matter, who should use them and how they can help streamline communication among healthcare workers. The goal is to provide insight into how using these forms can save your practice time, money and improve overall patient safety in the process.
| Question | Answer |
|---|---|
| Form Name | Physician Delegation Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | ocddwss pf 11 001 physician delegation, nurse delegation form for colostomy louisiana, louisiana physician delegation, louisiana delegation administration |
STATE OF LOUISIANA
DEPARTMENT OF HEALTH AND HOSPITALS
Office for Citizens with Developmental Disabilities
PHYSICIAN DELEGATION FOR MEDICATION ADMINISTRATION
AND MEDICAL TREATMENTS
Participant's NAME:
Medicaid Number:
PROVIDER AGENCY NAME:
EMPLOYEE NAME: (ONE NAME PER PAGE)
DATE:
PHONE NO:
MEDICATION / TREATMENT
DOSAGE / SITE
INSTRUCTIONS
I have provided the above named employee, of the named Medicaid service provider agency, with specific training and instructions concerning the administration of the medication(s) and medical treatment(s) listed. This employee is acting under my authority.
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DELEGATING PHYSICIAN’S SIGNATURE |
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DATE |
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PHYSICIAN’S NAME: |
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ADDRESS: |
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CITY: |
STATE: |
ZIP: |
PHONE: ( |
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I have been instructed concerning administration of the medication(s) and medical treatment(s) described above, and agree to administer only these medications and treatments and to do so according to the instructions given.
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EMPLOYEE’S SIGNATURE |
DATE |
NOTE: This form is valid only until there is any change in the approval granted herein. Changes in authorized attendant, medication, dosage, treatment, or instructions require the completion of a new form prior to implementation of the change.
Revised