Get Snf/hha Discharge Summary Form - Tufts Health Plan

This guide provides clear and detailed instructions on completing the SNF/HHA Discharge Summary Form for Tufts Health Plan. Following these steps will help ensure accurate submission for all skilled nursing, home health agency, or comprehensive outpatient rehabilitation facility discharges.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In section I, fill in the member's name and ID number, the case manager or discharge case manager's name along with their contact information, and the primary care provider's details.
3. Indicate the type of service by checking the appropriate box for SNF, HHA, or CORF. Then, provide the date when skilled services should end, and the date the Notice of Medicare Non-Coverage (NOMNC) was issued to the member or their representative.
4. In section III, verify and document the necessary elements that need to be in place prior to discharge. Ensure all relevant discussions and notes are recorded, including those with the attending physician and member or family.
5. In section IV, provide specific information on the patient's current medical condition and justify why services are no longer necessary. Use full sentences and avoid abbreviations.
6. Document the patient’s level of functioning prior to admission, detail the treatment plan, and describe therapy goals set for discharge.
7. State the patient's current medical and rehabilitation status, including any barriers affecting progress towards goals.
8. Conclude section IV by indicating the physician's assessment of the patient's stability for discharge and outline the discharge plan and follow-up care.
9. Finally, fill in the printed name and signature of the individual completing the form, along with their phone number for further contact.
10. Review the entire form for accuracy. After completion, save your changes, download the form, print it, or share it as needed.

Complete your SNF/HHA Discharge Summary Form online today to ensure seamless discharge processing.