Get Dhs 4691 Eng

Filling out the Dhs 4691 Eng form online is an essential process for documenting personal care assistant (PCA) activities and time spent providing care. This guide will walk you through each step to ensure accurate and compliant completion of the form.

Follow the steps to successfully complete the Dhs 4691 Eng online.

1. Press the ‘Get Form’ button to access the form and open it in your selected editor.
2. Enter the name of the PCA agency in the designated field, followed by their phone number.
3. Document the dates of service by entering the dates in the mm/dd/yy format for each day services were provided, ensuring they are in consecutive order.
4. In the 'Activities' section, mark your initials next to all activities you provided assistance with during the service dates.
5. For each visit, enter the time in and time out in hours and minutes, circling AM or PM for clarity.
6. Indicate the ratio of PCA to recipient for each visit, selecting from 1:1, 1:2, or 1:3, and write any shared services location if applicable.
7. Calculate the total time spent in minutes for all visits and enter the totals in the appropriate fields.
8. Under 'Acknowledgement and Required Signatures', ensure both the recipient and PCA sign the form. Include names and identifying numbers as required.
9. Review all entries for accuracy, then save your changes, and if needed, download, print, or share the completed form.

Complete your Dhs 4691 Eng form online today to ensure your documentation is accurate and compliant.