Common use of CLIENT CARE AND OTHER CONTRIBUTING Clause in Contracts

CLIENT CARE AND OTHER CONTRIBUTING. FACTORS TO THE OCCURRENCE Change in Client Acuity. Provide details: Safety in Jeopardy. Please specify: Complex Family dynamics: Click here to enter text Urgent/same day assessments: Click here to enter text. Clients assigned at time of occurrence: Lack of /malfunctioning equip/technology. Details: Non-CM duties. Specify: Weather / Conditions # of new clients to be assessed: Travel / Distance internal/external transition of service: Unanticipated Assignment / Uncontrolled variables: Pls. Specify: RAI assessments/XXXXX to be completed Other (specify): Please provide details about the working conditions at the time of occurrence by providing the following information e.g. shortage of staff, number of visits, meetings/case conferences, education/inservice, presentations, mentoring: Click here to enter text. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply (if known): Absence/Emergency Leave Sick Call(s) Vacancies

CLIENT CARE AND OTHER CONTRIBUTING. FACTORS TO THE OCCURRENCE Change in Client Acuity. Provide details: Safety in Jeopardy. Please specify: Complex Family dynamics: Click here to enter text Urgent/same day assessments: Click here to enter text. Clients assigned at time of occurrence: Lack of /malfunctioning of/malfunctioning equip/technology. Details: Non-CM Care Coordinator duties. Specify: Weather / Weather/Conditions # of new clients to be assessed: Travel / Travel/Distance internalInternal/external transition of service: Unanticipated Assignment / Assignment/Uncontrolled variables: Pls. Specify: RAI assessments/XXXXX to be completed Other (specify): Please provide details about the working conditions at the time of occurrence by providing the following information information, e.g. shortage of staff, number of visits, meetings/case conferences, education/inservicein-service, presentations, mentoring: Click here to enter text. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply (if known): Absence/Emergency Leave Sick Call(s) Vacancies

CLIENT CARE AND OTHER CONTRIBUTING. FACTORS TO THE OCCURRENCE Change in Client Acuity. Provide details: Safety in Jeopardy. Please specify: Complex Family dynamics: Click here to enter text Urgent/same day assessments: Click here to enter text. Clients assigned at time of occurrence: Lack of /malfunctioning of/malfunctioning equip/technology. Details: Non-CM Care Coordinator duties. Specify: Weather / Weather/Conditions # of new clients to be assessed: Travel / Travel/Distance internalInternal/external transition of service: Unanticipated Assignment / Assignment/Uncontrolled variables: Pls. Specify: RAI completed assessments/XXXXX to be completed Other (specify): Please provide details about the working conditions at the time of occurrence by providing the following information information, e.g. shortage of staff, number of visits, meetings/case conferences, education/inservicein-service, presentations, mentoring: Click here to enter text. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply (if known): Absence/Emergency Leave Sick Call(s) VacanciesVacancies Date Click here to No

CLIENT CARE AND OTHER CONTRIBUTING. FACTORS TO THE OCCURRENCE D Change in Client Acuity. Provide details: D Safety in Jeopardy. Please specify: D Complex Family dynamics: Click here to enter text D Urgent/same day assessments: Click here to enter text. D Clients assigned at time of occurrence: D Lack of /malfunctioning of/malfunctioning equip/technology. Details: D Non-CM Care Coordinator duties. Specify: Weather / D Weather/Conditions D # of new clients to be assessed: Travel / D Travel/Distance internalD Internal/external transition of service: D Unanticipated Assignment / Uncontrolled Assignment/LI ncontrolled variables: PlsPis. Specify: D RAI assessments/XXXXX to be completed D Other (specify): D Please provide details about the working conditions at the time of occurrence by providing the following information information, e.g. shortage of staff, number of visits, meetings/case conferences, education/inservicein-service, presentations, mentoring: Click here to enter text. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply (if known): D Absence/Emergency Leave D Sick Call(s) D Vacancies