Follow the steps to complete your Nursing Assessment

1. Press the ‘Get Form’ button to access the Nursing Assessment form and open it in your chosen editor.
2. Contact the individual receiving care, their family member(s), or guardian to schedule a face-to-face meeting. During this interaction, explain the purpose of the Nursing Assessment form clearly.
3. During the meeting, review the current physician’s orders to identify the required nursing tasks that need to be addressed.
4. For each nursing task, classify it appropriately by selecting ‘1’ for specifically recognized tasks that may be assigned without further review or ‘2’ for nursing authorized only under specific circumstances affecting the individual’s medical status.
5. Select from the dropdown options available for each skilled task ordered by the physician, indicating how the requirements are currently being met.
6. If a task requires the skills of a licensed nurse, select ‘yes’ in the Nursing Requested column to ensure it is documented appropriately.
7. For every classification ‘2’ task assigned, provide a written explanation in the ‘Comments’ section outlining the specific nursing need that necessitates this classification.
8. Document the number of times per day that each licensed nursing task will be performed in the ‘Comments’ section as required.
9. On the final page labeled ‘Proposed Nursing Schedule,’ document the days and times of nursing visits, the duration of each visit, and whether services will be under waiver nursing or state plan nursing.
10. Submit the completed Nursing Assessment Form via email to TDDInbox@DODD.Ohio.gov, along with the annual budget or any adjustments needed due to significant changes in the individual’s condition.
11. Follow up to ensure DODD has reviewed the Nursing Assessment Form. They will notify you if the service request is Approved, Denied, or Incomplete.
12. If the request is partially approved or denied, DODD will send hearing rights information to the individual/family/guardian for review.
13. Once approved, DODD will send an email notifying the county board representative of the nursing service authorization, allowing the county board to contact the nursing provider and update the Individual Support Plan (ISP) as necessary.

Begin filling out your Nursing Assessment form online today to ensure proper nursing care is provided.