What Credentials Need to Be in Field Staff HR Files for Home Health & Hospice?

If a surveyor opened your field clinician files today, would everything be in order? Missing one credential, even if it seems minor, is a deficiency. And deficiencies tied to HR files are easy to find because surveyors know exactly what to look for.

As a home health or hospice owner, you’re not just responsible for care. You’re responsible for proving your clinicians are qualified to provide it. That proof lives in your HR files.

Many agency owners are surprised when surveyors cite them for missing documents they thought weren’t needed anymore. These documents could be a physical card for licensure, outdated TB forms, or even a CPR card completed online.

After decades of guiding agencies through Medicare regulations and surveys, we’ve seen what trips people up the most. At the Home Health Consultant, we want to share what we’ve learned over hundreds of surveys so your agency can stay ahead of the curve.

By the end of this article, you’ll know exactly what credentials your clinician HR files need to include and why each piece matters.

Required Health Documents for Home Health and Hospice Clinicians

Before a clinician ever sees a patient, you need documentation that shows they are physically capable of doing the work, and they are safe to be around vulnerable populations.

Physical Examination

Start with the physical exam. This must clearly state that the clinician is free from communicable diseases and physically able to carry out their duties. That language matters. A vague note from a physician won’t cut it.

Timing is also incredibly important. The physical must be completed within six months before hire or up to two weeks after the start date. If your clinician comes from a staffing company, the same window applies, but it’s based on their first patient visit with you.

Keep in mind that this isn’t a one-time requirement. Physicals expire annually and need to be updated every year to remain compliant.

Proof of Tuberculosis Clearance

You’ll also need annual TB clearance. Clinicians can either get a PPD test or a chest X-ray. If they’ve tested positive on a PPD in the past, the chest X-ray is required. PPDs are valid for one year, while chest X-rays last two. If you go the X-ray route, you’ll need the actual X-ray report, just having a form isn’t enough.

Because some clinicians may not want the extra exposure to radiation, in some cases staff are allowed to complete a TB self-assessment checklist annually after the initial x-ray. That’s acceptable in many states, but always check your state’s requirements.

Finally, hepatitis clearance is also required. Like the physical and TB test, it must be renewed annually. Clinicians aren’t required to get the Hepatitis B vaccine, but they must at least sign a declination form if they choose not to receive it.

Flu Vaccination (Optional but Encouraged)

When it comes to vaccination, the annual flu shot isn’t federally mandated, but it is a hot topic in healthcare and during surveys. Surveyors look for:

• education,
• vaccination status tracking,
• And declination forms

…if your staff chooses not to be vaccinated. Influenza prevention is heavily emphasized in healthcare, including a mandated flu vaccination program which must be accurately run and documented annually.

What Clinical Credentials Must Be in an HR File?

Surveyors want to see clear proof that every field clinician is qualified by education, license, and training to perform their duties.

Work History Requirements

That starts with a resume or documented work experience and education history. This isn’t just about showing they’ve worked in healthcare. Home health and hospice are unique in that clinicians are working alone, without onsite support. Most states, including California, require that clinicians have at least one year of licensure before working independently in the home. Your HR file should show that timeline clearly. If the clinician does not submit a formal resume, a completed job history form will meet the requirement.

Professional Credentials Requirements

Then there your team's the professional licenses. This includes:

• Registered Nurses (RNs)
• Licensed Vocational Nurses (LVNs)
• Physical Therapist (PTs) 
• Occupational Therapists (OTs)
• Speech Language Pathologists (SLPs)

However, over the past few years, the way you show proof of a professional license has changed slightly in some states. In California, for example, you're no longer expected to keep physical license cards on file. Instead, surveyors prefer you use the state’s online license verification tools. 

If your state offers online verification, we recommend using this method as long as it is acceptable in your state. By using online verification, your agency can decrease the risk of missing a license expiration date, only to realize during a survey. Even if the clinician has since had their license renewed, if you have an expired one on file, you will receive a citation. Licenses can also be revoked or suspended even if a card looks current, so you want to make sure you consistently have access to the most up-to-date information.

For social workers, the rules are a bit different. If they’re licensed clinical social workers (LCSWs), you’ll need license verification. If they’re Medical Social Workers, they’re not licensed. But, you still must keep a copy of their Master’s degree in social work, on file, to show they meet qualifications.

Certified Home Health Aides (CHHAs) don’t hold licenses, but rather certificates. You can verify these certificates through your state’s public health database. In California, that’s through the CDPH verification site.

CPR Certification Requirements

CPR certification is also a must. This requirement applies to anyone going into a patient’s home, even if they don’t provide direct care. While parts of the CPR training can be online, the CPR skills check must be done in person. That’s non-negotiable. Surveyors will cite you if CPR certification doesn’t include an in-person component.

Malpractice Insurance (Optional but Encouraged)

Finally, while not federally required, malpractice insurance is strongly recommended. It’s a low-cost, high-protection safeguard for both the agency and the clinician. Many policies are under $200 a year, and if something goes wrong in the home, you’ll be glad it’s in place. While we don’t have a preferred vendor, many clinicians have used NSO and have been happy. 

Transportation Requirements for Home Health Staff

Because home health and hospice clinicians travel from home to home, surveyors expect documentation proving they can legally and safely do so.

Driver’s License Requirements

That begins with a valid driver’s license. There are rare exceptions where a clinician might use rideshare services or have a driver, but this must be documented clearly. Surveyors will not accept assumptions. Clinicians using ride-share services also have the potential to create HIPAA violations, so it’s important to know how your team is traveling. If you want to make sure your agency is following HIPAA rules, check out our article on the topic below.