miscommunication; it also builds a valuable bond. How does one go about making a home visit? ❚ Scheduling. What often works best in a busy practice is to schedule home visits for the end of the workday or to devote an entire afternoon to making home visits to several patients in one locale. Also important is scheduling times, if possible, when important family members or other caregivers are at home or when other members of the home care team can accompany you. ❚ What to bring along. Carry a “home visit bag” that includes equipment you’re likely to need and that is not available away from your office. A minimally equipped visit bag would include different-sized blood pressure cuffs, a glucometer, a pulse oximeter, thermometers, and patient education materials. Other suggested contents are listed in TABLE 1. Due to the COVID-19 pandemic, providers should also carry adequate personal protective equipment (PPE), including an N-95 mask. ❚ Dos and don’ts. Take a few minutes when you first arrive to simply visit with the patient. Sit down and introduce yourself and any members of the home care team that the patient has not met. Take an interim history. While you’re doing this, be observant: Is the home neat or cluttered? Is the indoor temperature comfortable? Are there fall hazards? Is there a smell of cigarette smoke? Are there any indoor combustion sources (eg, wood stove or kerosene heater)? Ask questions such as: Who lives here with you? Can you show me where you keep your medicines? (If the patient keeps insulin or any other medicines in the refrigerator, ask to see it. Note any apparent food scarcity.) During your exam, pay particular attention to whether vital signs are appreciably different than those measured in the office or hospital. Pay special attention to the patient’s functional abilities. “A subtle, but critical distinction between medical management in the home and medical management in the hospital, clinic, or office is the emphasis on the patient’s functional abilities, family assistance, and environmental factors.”33 Observe the patient’s use of any home technology, if possible; this can be as simple as home oxygenation or as complex as home hemodialysis. Assess for any apparent caregiver stress. Finally, don’t neglect to offer appropriate emotional and spiritual support to the patient and family and to schedule the next follow-up visit before you leave. ❚ Documentation and reimbursement. While individual electronic medical records may require use of particular forms of documentation, using a home visit template when Patients with diabetes receiving home care are more likely to have improved quality of life, lower HbA1c levels, and lower systolic BP readings. HOME VISITS MDEDGE.COM/FAMILYMEDICINE VOL 69, NO 10 | DECEMBER 2020 | THE JOURNAL OF FAMILY PRACTICE 511 Using a home visit template can help with documentation and reimbursement. TABLE 1 Home-visit bag contents Essentials • Laptop, tablet, and/or smartphone with access to the patient’s electronic medical record or printed copy of the patient’s demographic information and record of latest visit • Prescription pad if any scripts will be handwritten • Business card or printed practice contact information • Portable scales (adult/infant) • Tape measure • Thermometer • Blood pressure cuffs (adult/child/infant) • Stethoscope • Pulse oximeter • Alcohol wipes • Glucometer and test strips • Small centimeter ruler (for measuring skin lesions) • Tongue depressors • Penlight or headlamp • Personal protective equipment, including an N-95 mask if available Extras • Baby wipes • Urine specimen cups/infant urine collection bag • Permanent marking pen • Tourniquet • Venipuncture needles and vacutainers • Sharps disposal box • Gauze, tape, and adhesive bandages • Lubricant jelly • Hemoccult collection cards • Medical scissors • Chlorhexidine or betadine swabs • Culturette collection tubes • Portable ultrasound • HIPAA-compliant camera & software • Patient consent forms • Patient handouts for common conditions • Handicapped parking forms • List of local community resources HIPAA, Health Insurance Portability and Accountability Act. possible can be extremely helpful (TABLE 2). A template not only assures thoroughness and consistency (pharmacy, home health contacts, billing information) but also serves as a prompt to survey the patient and the caregivers about nonmedical, but essential, social and well-being services. The document should be as simple and user-friendly as possible. Not all assessments will be able to be done at each visit but seeing them listed in the template can be helpful. Billing follows the same principles as for office visits and has similar requirements for documentation. Codes for the most common types of home visits are listed in TABLE 3. Where can I get help? Graduates of family medicine residency programs are required to receive training in home visits by the Accreditation Council for Graduate Medical Education (ACGME). Current ACGME program requirements stipulate that “residents must demonstrate competence to independently diagnose, manage, and integrate the care of patients of all ages in various outpatient settings, including the FMP [family medicine practice] site and home environment,” and “residents must be primarily responsible for a panel of continuity patients, integrating