2017 home health systems order form revision 7.20175.00 manual $425.00 $279.00 $279.00 ... and...
TRANSCRIPT
Order Form
P.O. Box 21704 • St. Simons Island, GA 31522-0804(800) 961-7122 • (912) 634-0469 • www.HomeCareandHospice.com
Fax this completed order form to 800-649-0017. Thank you for your order!
F E A T U R E D P R O D U C T S
Product Code Description Price TOTAL
Infection Control in Home Care and Hospice, Second Edition
Home Care Infection Prevention and Control Program
Hospice Medication Management
Annual Update: Home Care Infection Prevention & Control Program
Home Care Medication Management
Contact InformationName:
Title:
Organization Name:
Address:
City:
State:
Type of business:
E-mail Address:
Phone Number:(Used for delivery purposes)
Zip + Postal Code:
Home Health Hospice Home Infusion (Pharmacy) Private Duty DME Other
product information by E-mail: Yes No
Name:
Street Address:(No P.O. boxes please)
City:
State:
Phone Number:
Zip + Postal Code:
Billing Information
Attention:
Street Address:(No P.O. boxes please)
City:
State:
Phone Number:(Used for delivery purposes)
Address is a:
Zip + Postal Code:
Business Residence
Shipping Information
Check Payable to Home Health Systems, Inc. (Mail to address below)
Credit Card:
1
Expiration: Mo. Yr. CVV2 Security Code:
2
Cardholder Name:
Signature:
Visa MasterCard AmEx Discover
Account Number:
Payment Method (Check One)
Sub Total:
Sales Tax:(GA ship-to address add applicable sales)
Shipping & Handling:
Total:Order Date:
Shipping & Handling
Orders up to $100.00
Orders over $100.00
$6.95
5% of Order
$10.95
10% of Order
$18.95
20% of Order
United States Canada Outside U.S. & Canada
BO
OK
TO
OL
KIT
S
IC2906
IC1017
MM2107
IC1000
MM1107
Home Care and Hospice Medication ManagementMM3107
Quantity
$175.00Manual
$425.00
$279.00
$279.00
$299.00
$259.00
Featured Publication
Book
Discount:Source Code:(If applicable)
* Single-site license with the complete contents of the Manual and collateral material. Option to add sites at a discount per additional site. Prices subject tochange without notice. UPDATED
This comprehensive, evidenced-based infection prevention and control program for home health agencies and hospices includes policies and procedures, forms, tool, and checklists that address care provided in the home, as well as hospice care provided in an inpatient hospice unit and residential hospice facility. The manual includes everything needed to implement the home health, and hospice infection prevention and control accrediting body standards and Conditions of Participation.
Home Care Infection Prevention and Control Program