1. Session #4: Steps 4 & 5 Greeting Patients Limitation of Services

2. Step 5: Limitation of Services OT Page 47 OT Page 47 Greeting (script) Greeting (script) Take her What Can You Expect Form Take her What Can You Expect Form Return WCYE to PR Director as directed Return WCYE to PR Director as directed WCYE is not a part of patient’s chart WCYE is not a part of patient’s chart Ask if patient has any questions about what she read in Reception Ask if patient has any questions about what she read in Reception Respond with script to again review services Respond with script to again review services

3. Step 5: Limitation of Services Review Page 1 of Patient Intake Form Review Page 1 of Patient Intake Form Limitation of Services Limitation of Services Read through each bulleted item Read through each bulleted item Give her time to ask questions Give her time to ask questions Permission to Contact Permission to Contact Include any special notes about contacting her (i.e. do not say “pregnancy”, call after 5pm, call my cell phone only) Include any special notes about contacting her (i.e. do not say “pregnancy”, call after 5pm, call my cell phone only)

5. Step 5: Limitation of Services Review Page 1 of Patient Intake Form Review Page 1 of Patient Intake Form Limitation of Services Limitation of Services Read through each bulleted item Read through each bulleted item Give her time to ask questions Give her time to ask questions Permission to Contact Permission to Contact Include any special notes about contacting her (i.e. do not say “pregnancy”, call after 5pm, call my cell phone only) Include any special notes about contacting her (i.e. do not say “pregnancy”, call after 5pm, call my cell phone only)

6. Step 5: Limitation of Services RETURN VISIT This step is not necessary during a return visit, provided the signed form is in the chart This step is not necessary during a return visit, provided the signed form is in the chart PR Return Visit Form is used during the Return Visit PR Return Visit Form is used during the Return Visit No changes should be made on the Patient Intake Form once the Initial Visit is completed. No changes should be made on the Patient Intake Form once the Initial Visit is completed. All notes/changes should be made on specific form, or on Patient Contact Form. All notes/changes should be made on specific form, or on Patient Contact Form.