SAMPLE POLICY WORK

XXXV. Record Maintenance Record keeping is a critical operation at Simpl Care Services LLC that underpins every element of service delivery, regulatory compliance, and quality improvement. A robust record keeping system ensures continuity of care for clients, supports transparent decision-making by management, and serves as the foundation for internal audits, external reviews, and regulatory inspections. All records — from individual client files and service documentation to financial and personnel records — must be maintained with the highest level of accuracy, security, and accessibility. This section outlines our comprehensive record keeping policies and procedures, detailing their purpose, scope, required elements, guidelines for data security and retention, roles and responsibilities, as well as continuous improvement methods.

a. Purpose and Objectives

Purpose Statement The primary purpose of our record keeping policy is to ensure that every document generated in the course of our operations is maintained accurately and securely. A meticulous record keeping system is essential to support: • Seamless communication and coordination across departments. • Continuity and quality of client care through detailed historical records. • Compliance with the Tennessee CAC Waiver (TN.0357.R05.00), TennCare guidelines, and all state and federal regulations. • Transparency and accountability in case of audits or regulatory reviews. • Data-driven decision making through rigorous documentation of processes and outcomes. The ultimate goal is to support high-quality, person ‑ centered care while also rendering our operations auditable and compliant with all applicable mandates.

Objectives Our record keeping policy is driven by several key objectives:

• Maintain complete, up ‑ to ‑ date records across all operational areas. • Establish strict retention schedules for different categories of records in accordance with legal requirements. • Enforce rigorous data security measures to safeguard sensitive client and employee information in compliance with HIPAA and other relevant privacy laws. • Define clear roles and responsibilities for the creation, maintenance, storage, retrieval, and secure destruction of records. • Provide standardized procedures to ensure that documentation is consistent, transparent, and accessible to authorized personnel at all times. • Enable effective quality improvement through the systematic collection, storage, and analysis of data from all operational areas.