Get Personal Care Services Plan - Nd

The Personal Care Services Plan - Nd is a crucial document for individuals seeking personal care services in North Dakota. This guide provides step-by-step instructions to help you navigate the online filling process with ease and confidence.

Follow the steps to successfully complete your form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online document editor.
2. Begin by filling out Section I - Client Information. Enter the client's last name, first name, and middle name, along with their Medicaid number, address, county of residence, city, state, and zip code.
3. Move to Section II - Personal Care Services Eligibility. Here, input the appropriate scoring for activities of daily living (ADL) and instrumental activities of daily living (IADL) as applicable. Ensure you indicate both the meal preparation eligibility and the date of the comprehensive assessment.
4. In Section III - Approved Services, provide the provider number, list the PCS provider, and specify the authorized units and procedure codes, including billable units/days and total billable units/days.
5. Proceed to Section IV - Other Services if applicable, noting any additional services required.
6. Complete Section V - Signatures. Ensure the client and case manager sign and date the form, indicating an understanding of any service reductions and their rights.
7. Review all sections thoroughly for accuracy. Once completed, you can save changes, download the document, print it, or share it as necessary.

Start filling out your Personal Care Services Plan - Nd online now for a smoother experience.