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Swing Bed Survey
Swing Bed Survey
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Created by Qualaris Staff
Critical Access Hospital
Case Management
Table of Contents
Audit Form
Audit Form
Swing Bed Survey
Description
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Required
Observed Date
Total number ot Swing days
Do not enter protected health information (PHI)
Discharge Goal
Select an Option
Actual Discharge Disposition
Select an Option
Was Discharge goal met?
yes
no
n/a
Skilled Need
PT/OT
IV Therapy
Palliative Care/ Comfort measures
Other
Is Skilled Need Documented on Daily? Performed Daily?
Yes
No
Refused or Unable to Performed but Documented
Swing Bed Survey Checklist
Mark all as...
Medicare Certification Signed and Dates Correct?
Yes
No
Patient Bill of Rights Signed?
Yes
No
N/A
NOMNC Signed?
Yes
No
N/A
Complete Discharge from Acute Status and Complete new admission to Swing?
Yes
No
