Get Form 450b Worksheet For Nursing Facility Internal Use Only ... - Myweb In

This guide provides comprehensive instructions on how to effectively complete the Form 450B Worksheet for nursing facilities. By following these steps, users will ensure accurate and efficient submission of essential information for nursing facility assessments.

Follow the steps to complete the form online:

1. Press the ‘Get Form’ button to access the Form 450B worksheet and open it in the editor.
2. Identify the type of request at the top of the form by selecting either 'Long-term' or 'Short-term'.
3. Specify the assessment type by checking the appropriate box for the request you are submitting.
4. Indicate the pay status by selecting either 'Medicaid', 'Medicaid Pending', or 'Private Pay'.
5. Select the agency to which this form should be directed, either 'DA Central office' or the relevant 'AAA'.
6. Provide the name, telephone number, and email address for the contact person at the nursing facility.
7. Complete Section I for applicant information, including the last name, first name, middle initial, date of birth, sex, Medicaid number, Social Security number, admission date, discharge date, and facility provider number, marking 'No LPI available' if necessary.
8. Fill in Section II for physician medical evaluation, entering the primary and secondary diagnoses along with their respective dates.
9. For the eligibility screen, select the applicable options related to ambulation, bedfast status, incontinence, catheter usage, seizures, and any other relevant medical information.
10. Provide details regarding any administered medications, dietary needs, cognitive impairment, and overall condition of the applicant.
11. Review the form for completeness, ensuring all sections are filled out accurately.
12. Once all fields have been completed, save changes, download, print, or share the form as needed.

Complete your Form 450B Worksheet online for a smooth submission process.