ADDITIONAL PAGES MAY BE USED. Page of Reissued November 6 2015 Replaces June 25 2015 Issuance OAAS-PF-11-015 Page 1 of 7 WEEK OF THROUGH DAILY SERVICES/SUPPORTS DESCRIPTIONS COMMENTS AND PROGRESS NOTES DAY OF WEEK AND DATE DESCRIPTIONS COMMENTS AND PROGRESS NOTES Instructions for Completion of Community Choices Waiver CCW Service Log The Community Choices Waiver CCW Service Log hereinafter referred to as the Service Log is used by CCW participants receiving Personal Assistance Services PAS. COMMUNITY CHOICES WAIVER CCW SERVICE LOG PROVIDER AGENCY NAME DIRECT SERVICE WORKER S NAME PARTICIPANT NAME PARTICIPANT DOB Week Of Day Of Week Date 1st Arrival Time w/ Initials 1st Departure Time w/ Initials 2nd Arrival Time w/ Initials 2nd Departure Time w/ Initials Through Sunday Monday Tuesday Wednesday Thursday Friday Saturday Indicate Task Completed Each Day W/Initials in Column for the Type PAS provided Tasks F O R A M P Eating Bathing Dressing Grooming Transferring Ambulation Toileting Light....
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How to fill out the LA OAAS-PF-11-015 online
The LA OAAS-PF-11-015 is an essential form for documenting personal assistance services provided under the Community Choices Waiver. This guide will walk you through the process of filling out this form online, ensuring proper documentation of services rendered to individuals in need.
Follow the steps to complete the LA OAAS-PF-11-015 form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the provider's name in the designated field to identify who is delivering the services.
- Print the name of the Direct Service Worker in the following section to credit the individual assisting the participant.
- Enter the participant’s name in the appropriate field to ensure the correct recipient is noted.
- Fill in the participant’s date of birth to verify their identity.
- Indicate the start date of the week for which services are being logged.
- List the days of the week, ensuring to provide the correct dates for each day within the authorization week.
- For each day, place initials next to the tasks that were actually completed by the Direct Service Worker.
- At the end of the week, ensure the signatures of the participant or their representative, as well as the Direct Service Worker, are documented with corresponding dates.
- Make any necessary notes on progress or changes observed during the week in the designated progress notes section.
- Upon completing the form, save your changes or download, print, or share the document as needed.
Complete your LA OAAS-PF-11-015 form online today for accurate documentation!
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Items 1 - 6 - COMMUNITY CHOICES WAIVER (CCW) PERSONAL ASSISTANCE SERVICES (PAS) LOG...
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