Get Nursing Home Communication Form

Filling out the Nursing Home Communication Form online is essential for timely and accurate communication regarding members in nursing facilities. This guide provides a clear, step-by-step method to assist users in completing the form with ease and precision.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the Nursing Home Communication Form and open it in your preferred online editor.
2. Begin by filling in the member’s personal details, including their name, identification number, and date of birth. Ensure accuracy when entering this information.
3. Select the product type by checking the appropriate box, which may include options such as SecureBlue, SeniorCareComplete, AbilityCare, or CareBlue.
4. Provide the date of initial admission to the facility and the admit diagnosis using the ICD-9 code and description.
5. Enter the facility’s name, contact person, phone number, fax number, provider ID, and county information accurately to ensure proper communication.
6. Identify the reason code for the member’s status change. Choose the appropriate reason based on the list provided, and be prepared to document multiple codes if necessary.
7. Document the effective date of the new status, along with the diagnosis for the new status.
8. Indicate if there is an inpatient hospital admission associated with this stay and provide the number of inpatient days.
9. Fill in the number of skilled and non-skilled days used during the nursing facility stay.
10. Utilize the notes section to include any additional relevant information or comments to assist in processing.
11. Once all fields are completed, review the information for accuracy. Save your changes, download, print, or share the form as necessary to ensure timely submission.

Complete your Nursing Home Communication Form online today to ensure effective communication and timely processing.