Chapter 16: Care Orders
Chapter Overview
What You'll Learn:
- How to open and filter the Care Orders list
- Statuses and attention badges
- Detail tabs
- Common Actions (OASIS / Non-OASIS, ROC, discharge, case manager)
Time to Complete: 20–25 minutes
Who Should Read This: Clinical Managers, RN Case Managers, Intake, Agency Administrators
Path: Sidebar → Clinical → Care Orders → /dashboard/care-orders
Billing-only: Care Orders are hidden.
Text-only. Labels match the screen.
16.1 What You See on the List
- Title: Care Orders
- Subtitle: Manage and track all patient care orders.
- Stats cards: Total Active Orders · Pending Assessment · Awaiting physician signature · Nearing Expiration
Filters:
- Search by patient name…
- Filter by Status
- Filter by Attention
- Filter by Case Manager
Table columns: Patient name · Care order period · Case manager (RN) · Physician · Branch (when multi-branch) · Status · Days remaining · Actions
16.2 Statuses
Status filter / chips include:
| Status |
|---|
| Pending Assessment |
| Pending QA Review |
| Pending Physician Signature |
| Active |
| Nearly Expiration |
| Expired |
| Pending Discharge |
| Discharged |
| Deceased |
| Cancelled |
| On Hold |
Awaiting physician signature also appears as a stat card and attention badge. After QA approve, the care order can be Active while MD signature is still an attention item — signature is not always a hard “cannot work” gate. See QA / OASIS chapters for the approve flow.
16.3 Attention Filter
Filter by Attention options:
- Needs attention
- Past due
- Recert pending
- ROC pending
- Awaiting physician signature
Badges with the same labels can appear on rows.
16.4 Care Order Detail Tabs
Open a care order. Tabs:
| Tab | Purpose |
|---|---|
| Overview | Episode summary |
| Schedules | Visits on the calendar for this episode |
| Visits | Visit list |
| Documents | Clinical / POC / related docs |
| Admission Docs | Admission packet documents |
| Communications | SMS/fax when permitted |
| History Log | Audit / history |
16.5 Actions Menu
Button label: Actions. Items appear based on status and clinical track (OASIS vs Non-OASIS). Common labels:
| Action | Typical use |
|---|---|
| View Details | Open overview |
| Edit Care Order | Edit episode fields (Pending Assessment / legacy Pending Physician Signature) |
| View Sent Order | View what was sent to physician (legacy Pending Physician Signature) |
| Log Communication | Note a communication |
| Initiate OASIS Recertification | OASIS recert path |
| Initiate Non-OASIS Recertification | Non-OASIS recert |
| Cancel Recertification | Cancel an in-flight recert |
| Initiate OASIS Discharge / Initiate Non-OASIS Discharge | Discharge paths |
| Initiate Patient Death | Death path (creates an OASIS Death assessment even on Non-OASIS episodes) |
| Initiate Transfer / Initiate Transfer Discharge | Transfer paths (OASIS track only) |
| Create OASIS ROC | Resumption of Care — ON_HOLD only, cert period still open, OASIS track |
| Create Physician Order | Physician order (Agency Admin or assigned Case Manager) |
| Change Case Manager | Reassign CM |
| Edit Discharge Details / Cancel Discharge | Adjust discharge (Pending Discharge) |
| Start New Admission | After Discharged only |
QA review is not started from this menu. Open Clinical → QA Center, find the document in Documents Queue, and click Review. Do not expect a Care Order Review Assessment shortcut to the QA page.
Resending a physician signature fax: use Patient or Care Order → Communications → Send fax (Chapter 9). That is the supported resend path after Approve. Do not rely on a Care Order Resend to Physician label for modern Active + awaiting-signature episodes.
There is no Create Add-On Order action. Care orders are created by system flows (for example on Admit Patient), not as a free-form “add-on order” button.
There is NO “Initiate OASIS SOC” action in this Actions menu. SOC is not triggered from here. When a patient is admitted through Patient Intake / Admit Patient (Chapter 14), the SOC assessment is created automatically as part of that episode. You cannot manually launch SOC from Care Orders.
Actions vary by clinical track and episode status:
- OASIS episodes show OASIS-prefixed actions (e.g. Initiate OASIS Recertification, Create OASIS ROC)
- Non-OASIS episodes show Non-OASIS-prefixed actions (e.g. Initiate Non-OASIS Recertification)
- Not all actions are visible at all times — they are conditional on status and track
- Create OASIS ROC is status-gated to ON_HOLD (open cert) only — it will not appear on Active orders
If you do not see "Create OASIS ROC" in the Care Order Actions menu, check these (in order):
- Status must be ON_HOLD — ROC is offered only after a Transfer puts the episode on hold. Active / Pending Assessment / Discharged orders never show Create OASIS ROC.
- Certification period must still be open — if the Care Order is ON_HOLD but the cert end date has passed, the menu shows Discharge / Death instead of ROC. Continue care later with a new admission / SOC if needed.
- Clinical track must be OASIS — Non-OASIS episodes never show Create OASIS ROC.
- You must be allowed to act on this episode — typically the assigned Case Manager (RN) or an Agency Administrator with Care Order edit permission.
- There is no Schedule Center fallback — OASIS ROC cannot be created from Create Manual Visit. Schedule Center excludes OASIS assessment visit types.
16.6 OASIS vs Non-OASIS Track
Episodes follow a clinical track:
- OASIS — SOC/ROC/Recert/Discharge assessments toward CMS submission
- Non-OASIS — parallel Non-OASIS SOC/Recert/Discharge forms (not submitted as OASIS to CMS)
Actions and documents follow the track. Details: OASIS chapters (20–22) and visit forms (19).
16.7 Physician Signature & QA (short)
- Assessment completed → often Pending QA Review.
- QA Approve activates the episode for operations (Active) and related billing prerequisites as configured.
- Awaiting physician signature may remain as attention until Confirm physician signature (in QA / document flows).
- Staff may still work under Active + attention — do not assume the old “nothing starts until MD signs” story.
16.8 When the certification period ends (critical scenarios)
"Care order date passed" is not one workflow. What the user can do depends on status, not only on whether today is after
periodEnd/ certification end.
A) Status still ON_HOLD, but certification end date has passed
The expire job only moves Active / Nearly Expiration → Expired. An ON_HOLD episode stays ON_HOLD even after the cert end date.
| Allowed | Not allowed |
|---|---|
| Initiate OASIS Discharge / Initiate Non-OASIS Discharge | Create OASIS ROC |
| Initiate Patient Death | Initiate Recertification (Recert is never offered on ON_HOLD) |
| View Details · Change Case Manager | Schedule Center OASIS create |
What to do: Discharge or document Death from Care Order Actions. If the patient returns to care later, start a new admission / new SOC — do not try ROC or Recert on this held episode.
B) Status Active (or Nearly Expiration) — how Recert works
- Open Care Order Actions.
- Choose Initiate OASIS Recertification or Initiate Non-OASIS Recertification (track-specific).
- Assign the RN and assessment date in the Recertification modal.
- System creates the successor episode path (compliance task + scheduled assessment visit). Next episode starts the day after the current certification end.
Gates:
- Must be the patient's responsible open Care Order
- No Recert already in progress (if pending → use Cancel Recertification first)
- OASIS: assessment dating follows the late-episode window (last 5 days of the cert period, with grace after end for the visit). Non-OASIS can be initiated during the episode
- OASIS also requires a minimum days-of-care before Recert can start (backend enforces)
Nearly Expiration is the same Recert path as Active — status flips when the episode is within ~5 days of cert end.
C) Status Expired — late Recert vs close-out
When Active/Nearly Expiration passes cert end (+ 1 grace day), status becomes Expired.
Late Recert (Actions → Initiate … Recertification) only if:
- This is the patient's most recent Expired Care Order
- There is no open responsible episode
- No newer Discharged episode after this cert end
- No Recert already in progress
In the modal, staff pick the next episode start date (from the day after cert end, within the late-recert scheduling range).
Or close the episode with Discharge / Death only if:
- Status is Expired
- No open responsible episode
- This row is the latest Expired for the patient/spell
- If Recert is already in progress → Cancel Recertification first, then Discharge/Death
Discharged never Recerts — only Start New Admission (new SOC).
16.9 Common Mistakes
- Looking for Create Add-On Order — not in the product.
- Looking for "Initiate OASIS SOC" in the Actions menu — it does not exist here. SOC is created automatically during Patient Intake (Chapter 14).
- Looking for Create OASIS ROC on Schedule Center / Create Manual Visit — OASIS assessments are Care Order / Admission workflows only.
- Looking for Create OASIS ROC on an Active Care Order — it only appears when status is ON_HOLD with an open certification period.
- Thinking ON_HOLD past cert end can Recert or ROC — it cannot. Use Discharge/Death, then new SOC if care continues.
- Confusing ON_HOLD + past cert end with status Expired — they are different menus and different rules.
- Treating Pending Physician Signature as the only post-QA state — Active + attention badge is common.
- Ignoring Filter by Attention when hunting past-due / recert work.
- Expecting Care Orders on billing-only agencies — hidden.
- Assuming OASIS and Non-OASIS episodes have the same Actions — they do not; actions are track-specific.
- Using Care Orders to open QA — use QA Center instead.
16.10 Quick Checklist
- Can filter by status and attention
- Know detail tabs including Admission Docs and Communications
- Can start recert / ROC / discharge from Actions for the correct track
- Understand Active vs awaiting signature attention
Next: Chapter 17: Medication Management or Chapter 21: OASIS Assessments