Get Mi Wf 12173 2018-2025

The MI WF 12173 is a critical document used for Skilled Nursing Facility and Acute Inpatient Rehabilitation Facility assessments. This guide will help you understand how to fill out the form accurately and efficiently, ensuring all necessary information is provided for processing.

Follow the steps to fill out the MI WF 12173 online effectively.

1. Click 'Get Form' button to obtain the MI WF 12173 online and open it in your preferred editor.
2. Begin filling out the member and facility information section, which includes fields such as member name, address, date of birth, policy number, and hospital.
3. Provide information about the admissions in the admission information section, including the admission date, physician details, and vital signs.
4. In the clinical information section, indicate the admitting doctor’s name and NPI number, along with any complications and surgical procedures.
5. Complete the mobility current functioning section, documenting the level of assistance needed for various activities, such as bathing and transfers.
6. Fill in the medication section, listing any significant medication changes and IV medications that may affect functioning.
7. Detail the skin status, focusing on wounds or incisions if applicable, and provide information on treatment and self-care capabilities.
8. In the discharge plans section, include anticipated discharge location and any barriers present.
9. Review all entries for accuracy and completeness, ensuring no fields are left blank. If a field does not apply to your situation, mark it as N/A.
10. Once you have finished filling out the form, save any changes, and choose to download, print, or share the document according to your needs.

Complete your MI WF 12173 form online today.