Get Ca Hcbs-10 2014-2025

The CA HCBS-10 form is crucial for documenting the plan of treatment for individuals receiving home- and community-based services in California. This guide will provide clear, step-by-step instructions to help users navigate the online filling process with ease.

Follow the steps to complete the CA HCBS-10 form online.

1. Press the ‘Get Form’ button to access the document and open it in your designated online editor.
2. Fill out the applicant/participant information in the first section. Provide the name, date of birth, address, phone number, and any applicable medical record numbers.
3. In the provider information section, enter the name, title, contact details, and provider number of the individual or service agency responsible for the care.
4. Indicate the primary care physician's name and contact information, ensuring to provide the relevant treatment period dates.
5. For medical information, include diagnoses and corresponding ICD-9 codes. If more space is needed, attach additional pages.
6. Confirm the applicable Medi-Cal home- and community-based program services by checking all that apply.
7. Select only one level of care from the provided options to specify the individual's care needs.
8. In the waiver-specific services section, check all services enrolled in the HCBS waiver program and provide the frequency code for each.
9. List any nonwaiver services, detailing frequency and funding sources if known.
10. Document the nutritional requirements by specifying diet types and feeding methods.
11. Complete the medication plan by listing all medications, including allergies and reactions where known.
12. Outline the treatment plan, detailing services, frequency, provider, and any necessary instructions for caregivers.
13. Describe functional limitations per physician orders and any relevant safety precautions or rehabilitation potential.
14. Detail activities permitted by physician orders and indicate any safety measures in place.
15. Summarize the mental status including any relevant cognitive or behavioral notes.
16. List durable medical equipment and providers used, alongside known funding sources.
17. Include any therapies or referrals made, documenting the reasons and progress status where applicable.
18. Articulate treatment goals and the discharge plan based on the individual’s needs.
19. Identify any training needs for the applicant or the family, detailing providers if necessary.
20. Summarize the status of the applicant/participant during the treatment period, ensuring to keep additional notes if required.
21. Ensure all required signatures are obtained before submitting a copy to the appropriate Medi-Cal In-Home Operations office.

Complete your CA HCBS-10 form online today to ensure timely processing of your services.