Get Medical Status Form

Filling out the Medical Status Form online is a straightforward process that helps verify the medical information necessary for home and community-based services. This guide provides clear and supportive instructions to assist users in completing the form accurately.

Follow the steps to complete the Medical Status Form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in an online editor.
2. Completing patient information: Fill in the patient's legal name, date of birth, social security number, Medicaid number, Medicare number, gender, street address, telephone number, city, state, and zip code.
3. Document diagnoses: Include primary and secondary diagnoses along with corresponding ICD-9 codes if available.
4. Indicate physician involvement: Record the number of days, within the last 14 days, that a physician or their authorized assistant has examined the patient and any changes made to the patient's orders.
5. Specify treatments and conditions: Answer whether the patient has received specific health treatments or conditions, marking ‘0’ for No, ‘1’ for Yes, and ‘2’ for Unknown for each item listed.
6. Detail skilled rehabilitation therapies: Record the total minutes of therapies administered or scheduled, entering ‘0’ if none, and ‘999’ if unknown.
7. Provide physician information: Enter the physician's name, address, phone number, and signature confirming the accuracy of the information provided.
8. Finalize and submit: After completing the form, review all entries for accuracy, and then save changes, download, print, or share the completed document as needed.

Start filling out your Medical Status Form online today to ensure timely processing of necessary services.