Get Medical Necessity Review Form For Support Surfaces Mnr-ss (pdf) - Mass

Filling out the Medical Necessity Review Form For Support Surfaces MNR-SS is an essential step in facilitating access to necessary medical equipment. This guide provides a clear and detailed walkthrough of each section to ensure that users can complete the form accurately and efficiently.

Follow the steps to successfully complete the MNR-SS form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by completing the member’s personal information. Include the member's name, MassHealth ID number, date of birth, and address in the designated fields to ensure proper identification.
3. Detail the primary diagnosis by selecting the appropriate options for the stage of pressure ulcers, and include secondary diagnoses as necessary.
4. Provide a comprehensive assessment of the wounds. For each wound, specify the type, stage, location, size (length, width, depth), color, and any associated characteristics such as drainage or undermining.
5. Indicate the functional and mental status of the member, detailing their mobility and cognitive abilities to provide context for their care needs.
6. Summarize any comorbid conditions and risk factors affecting the member's health, including medications that impact wound healing.
7. Outline the wound care plan, detailing necessary interventions such as nutritional support, incontinence management, and pain management strategies.
8. Assess the outcome of the treatment plan by indicating changes in the member’s condition over the past month and documenting whether conservative treatments have been effective.
9. Specify the intended location for the member’s support surface and outline the estimated duration of need.
10. Select the type of support surface being requested, ensuring to provide a description of the equipment necessary for the member's care.
11. Complete the prescriber and provider information sections, including signatures, to confirm the accuracy of the form.
12. Once all fields are completed, users can save their changes, download the form for printing, or share it as needed.

Complete your documents online to ensure timely access to necessary support surfaces.