Public Health Nursing Practice Manual
Standard of Practice
© 2007 LAC DPH-Public Health Nursing
of the initial home visit or within the timeframe agreed upon with the PHNS.
Fax the initial documentation on the LPFF (p. 1-10), Appendix C (p. 1) to the assigned REHS within 30 calendar days of the initial DPHN home visit.
Submit the original LPFF and Appendix C, nutritional assessment “What Does Your Child Eat”, growth chart, client consent form, client release of information form, Medi-Cal Outreach Questionnaire, and the PHN Assessment to the assigned CLPPP-PHN within 30 days of case closure.
Retain a copy of all forms for the district medical record.
Document in the NPMS:
File a copy of the PHN Assessment per the PHN Assessment Form instructions.
Evaluate caregiver satisfaction:
Give client satisfaction form to the caregiver for completion and submission in a pre-addressed, stamped envelope.