Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Enter the patient’s name and date of birth in the designated fields. Ensure that these details are accurate to properly identify the patient.
3. In the section labeled 'Certified Home Health Agency Name,' input 'Visiting Nurse Service of New York (VNSNY)'.
4. Indicate the date of the face-to-face encounter and the name of the individual performing the encounter. This may be a Medicare-enrolled physician or a non-physician practitioner.
5. Under the section for medical conditions, list the primary medical conditions that necessitate home health care for the patient.
6. Provide clinical findings that support the assertion that the patient is homebound. This is crucial as it demonstrates the patient's need for home health services.
7. Check all applicable home health services that are medically necessary for the patient, including skilled nursing care, physical therapy, occupational therapy, or speech/language therapy.
8. Lastly, the physician must sign and print their name along with the date to validate the certification.
9. Once all information is filled out, you can save changes, download, print, or share the completed form as needed.

Complete your documentation online to ensure proper home health care services are provided.