Get Data Sheet And Prescription For Personal Care Recipients - Gencmh

This guide provides a detailed overview of how to fill out the DATA SHEET AND PRESCRIPTION FOR PERSONAL CARE RECIPIENTS - Gencmh form online. Whether you are a case manager, a family member, or a guardian, this step-by-step approach will help ensure that all necessary information is accurately recorded.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to access the form. This will open the DATA SHEET AND PRESCRIPTION FOR PERSONAL CARE RECIPIENTS - Gencmh document in an editable format.
2. Begin by entering the CMH agency details, including the name and agency case number. This information identifies the agency responsible for the personal care recipient.
3. Complete the personal information section with the recipient's date of birth, sex, and social security number (SSN). These details are crucial for accurate record-keeping and identification.
4. Document the move-in date and the FIA Medicaid case number, ensuring that you keep this information current to avoid discrepancies.
5. Indicate the recipient's diagnosis as per the current DSM to provide insight into their medical needs.
6. Identify the type of guardianship and include the facility name along with the Medicaid recipient ID number. This will help establish the legal and healthcare context for the recipient.
7. Fill in the county of residence, phone number, and address details including city, state, and zip code to ensure that contact information is accurate.
8. Complete the Medicaid provider ID number while making sure that all provided details are accurate for seamless processing.
9. In the additional assessment section, fill out the global assessment of functioning and specify any relevant end date/reason if applicable.
10. Provide the name and contact details of the parent or legal guardian. This is crucial for obtaining consents and further communications regarding care.
11. Select the treatment/training objective by checking the appropriate box (rehabilitation, maintenance, or psycho-social adjustment). This defines the focus of care interventions.
12. Indicate the type of facility where the care will be provided, ensuring you check all that apply, such as MI, DD, AIS/MR, etc.
13. Document the personal care services required by checking the relevant boxes under each service category such as eating, toileting, bathing, grooming, dressing, transferring, ambulation/mobility, and taking medication.
14. Finally, ensure that all necessary signatures are obtained from the case manager, qualified case manager/physician, and case manager supervisor/nurse, along with the dates on which they signed.
15. Once all fields are completed accurately, you can save the changes, and the form can be downloaded, printed, or shared as needed.

Complete the DATA SHEET AND PRESCRIPTION FOR PERSONAL CARE RECIPIENTS - Gencmh form online now for a streamlined documentation process.