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  • La Oaas-pf-11-015 2021

Get La Oaas-pf-11-015 2021-2026

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

Filling out the LA OAAS-PF-11-015 form is essential for documenting services provided to OAAS participants. This guide serves to walk you through the process step-by-step to ensure accurate completion of the form online.

Follow the steps to successfully complete the LA OAAS-PF-11-015 form.

  1. Click ‘Get Form’ button to obtain the LA OAAS-PF-11-015 form and open it in your editor.
  2. Enter the name of the provider responsible for the services in the designated field.
  3. Print the name of the Direct Service Worker (DSW) who is providing assistance to the participant.
  4. Input the participant’s name into the appropriate section.
  5. Enter the participant’s date of birth correctly in the specified field.
  6. Fill in the beginning date of the prior authorization week, using the correct format (e.g., MM/DD/YY).
  7. Record the ending date of the prior authorization week, again following the specified date format.
  8. Indicate the date for each day services are scheduled, beginning with the correct date for the prior authorization week on Monday, and continuing through the week.
  9. On each day, the DSW must sign their initials next to the tasks performed, ensuring only completed tasks are marked.
  10. After completing the service log for the week, obtain the participant’s signature or that of their Responsible Representative at the specified section.
  11. The DSW must also sign and date the form at the end of the prior authorized week, ensuring this is done only after all services have been completed.
  12. For page two of the service log, replicate the necessary fields for progress notes and ensure they are filled out as required with handwritten entries where applicable.
  13. Once all sections are completed, review for accuracy before saving changes, downloading, or printing the form.

Complete your LA OAAS-PF-11-015 form online today to ensure timely service documentation.

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