To Nutrition Ink

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Welcome

• To Nutrition Ink

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What we will cover

• Facility Reports
• Billing Reports
• Payroll Reports
• Payroll Forms/New Hire Packet
• Forms and Reports Notebooks

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Facility Reports
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Consultant Dietitian Report Form SNF/RFEAKA CDR

• Fill out facility, Administrator, FSS/DSS, and
  Director of Nursing (DON) name
• Visitation dates. Include month, day and year.
• Hours worked. Use time in and time out and then
  total for the day. These should match your time
  sheet. Total the hours worked for the month.
  This should match your monthly summary report.
• Fill in your name and RD number. If another
  dietitian helped you, their information needs to
  be on this report as well.
• Tentative schedule for next month.
• Administrator list any issues that were
  addressed.
• Food Service Supervisor or DSS list any issues
  that need to be and/or were addressed
• Director of Nursing list any issues that need
  to be and/or were addressed
• List any meeting attended. Weight meeting, CQI
  meeting, Care plan etc.
• List any in-services given and by whom. RDs are
  required to do at least 3 in-services annually.
  Refer to in-service manual for schedule.
• List any current department goals.
• CQIs check which one was done.
• Give kudos and a good job for any improvements.
• Distribution check that each person/place has
  received a copy.
• There are different consultant report forms for
  different type of facility e.g., SNF, RFE,
  ADHCs, Prison, DD H/N, and Child Nutrition
  Programs - Angel View.

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Consultant Dietitian Report Form ICF DD H/N

• Date (month/day/year) and time (use time in /
  time out )
• Indicate that consultant book was signed.
• Check appropriate boxes
• Facility name House name
• Parent facility Corporate name
• For each item listed fill in the appropriate
  code. One meal per quarter per house should be
  observed at minimum.
• This is used for all DD H/N homes EXCEPT Angel
  View

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Consultant Dietitian Report Form Angel View ONLY

• The only difference between this form and the
  other DD H/N CDR is the NSLP section
• NSLP site monitoring is to be done before
  February 1 of each year. Monitoring quarterly is
  recommended.

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Nutrition Recommendation Form

• Check appropriate box
• Enter facility name
• Enter which station
• Date of visit
• Due date for completion.
• Follow-up on next visit.
• There are different forms for DD H/N homes,
  ADHCs, and prisons. Use the appropriate form
  for the facility.

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Monthly CQISNF

• There are 3 CQIs that are done on a quarterly
  basis. A different one for each month in the
  quarter. These are found in the Policy and
  Procedure Manual, in section 1. They have also
  been provided to you.
• Do one CQI each month and send a copy to
  Nutrition Ink. Track on the Dietary CQI
  Monitoring Form provided, on the CDR and monthly
  summary report.

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RFE CQI

• A monthly kitchen inspection is the CQI for this
  type of facility.
• The RFE CDR has additional pages that is the
  kitchen inspection form to be used.

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Monthly Report

• Enter your name
• Enter the month
• Enter the year
• List the parent/corporate name and under list the
  facilities that you worked at for the month.
• List the hours worked at each facility for the
  entire month
• List the number of hours the facility has
  contracted with Nutrition Ink. This is to ensure
  that we have a contract for the correct amount of
  hours needed to complete the work necessary.
• List any forms that have been left at the
  facility.
• Check mark if this facility is in need of new
  menus, or their current cycle menu will be
  finishing in the near future. Most facilities
  are on a scheduled time for rough drafts and/or
  new menus to be sent out, however, in some
  instances the facility hasnt returned rough
  drafts/changed menus at their option.
• Check if this facility is due for survey.
• Check if the facility has a new staff member,
  DON, DSS, Administrator. Note this at the bottom.

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Monthly Report Continued

• Input number of quarterly, semi-annual or annual
  assessments that were done during the month
• Check if you have mailed or faxed copies of the
  CDRs to Nutrition Inks office.
• Check if a QA and/or the CQIs were performed at
  the facility during the month.
• Enter number of hours if any billable hours were
  done for a facility at the office or at home by
  you. List the description of the project and in
  the comments section let us know what facility
  this was done for.
• Total the number of billable hours for the month.
• List any reimbursable expenses. List amount,
  date and attach receipt for each expense claimed.
• Sign
• Enter the total number of hours/days (1 day 8
  hour) for each.
• In the last box total all the boxes. (Not for
  1099s)
• Total miles from time sheets.

1099s have a slightly different form (no
mileage, no paid days off) Fax or e-mail into
Nutrition Ink on the 1st of each month. The
hours worked MUST match the hours on the CDR and
on time sheet(s). The hours on the CDR take
precedence over all others. Any discrepancies
will be discussed.
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Payroll Reports
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Time Sheet Employee

• Fill in your name.
• Enter the date of the beginning of the pay period
• Enter the last day of the pay period (15th for
  those paid twice a month and the 30th or 31st for
  those paid once a month).
• Enter the date for the hours worked. If you work
  at more than one facility a day list each
  individually.
• List the name of the facility worked. For VNA
  /Home Health visit list patients name
• List the number of hours worked at that facility
  for that day.
• List any Nutrition Ink materials that you have
  left for that facility on that day. For example
  if you leave the facility a Nutrition ink policy
  and procedure manual please list so that the
  billing can be done correctly.

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Time Sheet Continued

• List the name of the parent or corporate name of
  the facility that you worked at that day. If
  facility is a single facility with no corporate
  office list the name of the facility again
• Place a check for hour for that day are a
  VNA/Home health Visit. We need to know this
  because we pay a higher rate for these visits.
• Total the number of hours for the pay period.
  Double check addition.
• Complete the total number of pages included with
  your time sheet. If your time sheet is more than
  1 page, enter the total number of hours on the
  last page. This will let us know if we have
  received all the pages.
• Fax into Nutrition Ink by 830 am on the 1st and
  16th of the month. OR e-mail to nutink_at_aol.com
• For those that work in the CDCR prisons, there is
  an additional time sheet that must be submitted.
  This must be signed by the prison personnel.

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Payroll Forms
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New Hire Packet

• To be signed and returned to Nutrition Ink
• Employee Information Sheet
• Reference request
• Employment Eligibility Verification (I-9).
• Employee withholding Allowance Certificate (W4)
  (employee status only)
• Pay Chex Form
• RDs and Aggressive Consumers
• Safety and Health Policy form
• Nutrition Ink Acknowledgement form code of Safe
  Practices
• Competency Evaluation for Clinical Dietitians
• Information for Health Care Workers form
• ADA/CDR Code of Ethics cover page
• Consulting Agreement Upon request a signed copy
  will be provided.
• HIPPA Business Associate Addendum Page 11
• Annual Privacy checklist

• Copy for your information
• Safety and Health Program
• Code of Safe Practices
• Information for Health Care Workers
• ADA/CDR Code of Ethics
• RD Office procedures forms and reports protocol
• HIPPA Business Associate Addendum
• Summary of the HIPPA privacy Act

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Additional Items Required

• Copy of current RD card or verification letter
• Resume
• Copy of drivers license (required for I-9)
• Social Security Card (required for I-9)
• Optional documents from List B C on I-9 form
• Other document from List A on I-9 form.
• Completed Direct Deposit form and blank voided
  check
• Liability insurance (1099 status only)
• TB Test within last 6 months
• Current Free from communicable disease
  statement from MD
• Signed RD checklist
• Signature page of Employee Handbook (employee
  status only)

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Forms and Reports Notebooks

• Separate notebooks have been provided to you with
  copies of forms used for the different type of
  facility that you have been assigned.
• A separate notebook for billing and payroll forms
  has also been provided
• Keep one copy as your master. You may request
  certain forms in revisable format e.g., monthly
  summary report, or time sheets, so that they can
  be easily filled out and e-mailed in.
• These notebooks are to be returned to Nutrition
  Ink upon leaving the company.
• It is suggested that these notebooks be stored in
  the trunk of your vehicle so that you always have
  them available.

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Available on line

• The facility forms are available on-line. Visit
  our website www.nutritionink.com. Click on
  the link NI staff only and scroll down. The
  forms are in Acrobat Reader and require a
  password nutink. If there is a form that you
  need and is not available on line, call the
  office and we will send you a copy or copies
  and/or put it up on the website.
• If you have any questions about the report forms,
  payroll or billing forms, please call the office
  [phone]

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The End

• Thank you.
• Again, Welcome to Nutrition Ink