Follow the steps to complete the assessment form efficiently

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Start by entering the member's personal details in the 'Member/Facility Information' section. This includes their age, name, contract number, phone number, admission date, hospital name, admitting facility, NPI number, and the facility's address and contact information.
3. Proceed to the 'Clinical Information/Basics' section. Fill in the admission information like the admission date to the skilled nursing facility (SNF) or inpatient rehabilitation (IPR), the admitting doctor’s name and NPI number, and vital signs, including temperature, blood pressure, and whether the patient is continent or incontinent.
4. In the 'Mobility Current Functioning' section, detail the patient's mobility status and any assistive devices they may use. Indicate if they require total, maximum, moderate, or minimal assistance with transfers and daily activities.
5. Complete the 'Clinical Information/Medications' section by listing any significant medication changes that could affect the patient's functioning, including IV medications and their ending dates.
6. Address the 'Self-Care Current Functioning' section, noting the level of assistance required for activities of daily living such as bathing, dressing, and toileting.
7. Fill out the 'Discharge (DC) Plans' section, indicating the tentative discharge date, home evaluation date, and available support at home, including family or home health care.
8. Review the entire form for clarity and completeness, ensuring all fields are legible. If any section is not applicable, place 'N/A' as required.
9. Once all fields are completed, save changes, and choose to download, print, or share the form as necessary for submission.

Take the next step in your documentation by filling out the Michigan MA PPO SNF Fax Assessment Form online today.