Get 485 Medquest Form

Completing the 485 Medquest Form online can streamline the process of submitting your home health certification and plan of care. This guide will walk you through each section of the form, ensuring you understand the requirements for accurate and efficient completion.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Enter the start of care date in the format MMDDYY. This date represents when covered home health services began, aligned with the qualifications of the patient.
3. Specify the certification period by entering the 'From' and 'To' dates in the MMDDYY format. Ensure that the 'From' date matches the start of care date and the 'To' date does not exceed two months.
4. Input the patient's name as shown on their health insurance card, ensuring to include only the last name, first name, and middle initial.
5. Document all physician's orders for medications, including dosage, frequency, and route of administration for each medication. Use letters 'N' for new orders or 'C' for change orders.
6. Enter the principal diagnosis along with the ICD-9-CM code and the date of onset or exacerbation relevant to the patient's condition.
7. Record any pertinent surgical procedures, dates, and corresponding ICD-9-CM codes, or mark N/A if not applicable.
8. List all other pertinent diagnoses alongside their onset dates and codes, indicating any that have changed since the last form.
9. Indicate any durable medical equipment (DME) and non-routine supplies ordered by the physician.
10. Detail safety measures and nutritional requirements as specified by the physician, including diet and fluid needs.
11. Assess and check the patient's functional limitations and the activities they are permitted to perform.
12. Describe the patient's mental status and appropriate prognosis as determined by the physician.
13. Document orders for disciplines and treatments, specifying the amount, frequency, and duration of visits required.
14. Outline the rehabilitation goals, potential, and discharge plans as advised by the physician.
15. Enter the physician's name and the date the home health agency received the signed plan of care. Document the physician's certification and signature details as needed.
16. Finally, review the completed form for accuracy and save changes. You may then download, print, or share the completed form as required.

Complete your documents online for a smoother submission process.