Get Pennsylvania Department Of Public Welfare Cassp Services Plan Of Care Summary Name: Age: Time

Filling out the Pennsylvania Department of Public Welfare CASSP Services Plan of Care Summary can be essential for individuals seeking care services. This guide aims to provide clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the plan of care summary accurately.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering the name of the person receiving care in the 'NAME' field.
3. Next, fill in the 'AGE' field with the individual’s current age.
4. In the 'TIME PERIOD' section, specify the duration for which the services are being requested.
5. Fill in the 'DSM III R' and 'ICD 9 CODE' fields with the relevant diagnostic codes pertinent to the individual’s situation.
6. Complete the 'AUTHORIZING AGENTS' section by providing the county name and adding a signature if required.
7. Input the physician's name in the 'Physician Name' field to identify the overseeing medical professional.
8. Enter the respective numbers for 'BSU #' and 'MA #' as applicable to the provided services.
9. In the SERVICES section, detail each service by filling in the 'SERVICE', 'SYSTEM/PROVIDER', 'LENGTH OF SERVICE', and other fields as necessary.
10. For each service, complete the 'FUNDING SOURCE', 'COST PER UNIT', and 'TOTAL COST' sections to provide a complete financial overview.
11. Finally, establish a 'Review Date' to indicate when the plan will be reviewed again.
12. Once you have accurately filled out all sections, you can save changes, download, print, or share the form as needed.

Start completing your documents online to ensure proper care planning.