Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access and open the Butler County Routine Homemaker Personal Care Documentation form.
2. Begin filling in the general information section. Enter the person's name, Medicaid number, contract provider number, service period, and provider information as required.
3. In the support area section, indicate whether the services are routine, on-site/on-call, or level I emergency by checking the appropriate box.
4. Specify the frequency of service by filling in the frequency fields. Use 'daily', 'weekly', 'monthly', or 'yearly' as applicable, along with the corresponding number of units.
5. Select the skill development codes applicable to the individual's support. Each code corresponds to a specific type of assistance, such as 'I' for independently or 'HOH' for hand over hand assistance.
6. Complete the sections for documenting the time in and time out of services, as well as the actual units provided, ensuring accuracy.
7. At the bottom of the page, provide initials and signatures in the designated areas to confirm the documentation and support provided.
8. If there are any variations in service, note the date, type of variation, reasons for the variation, and actual staff-to-individual ratios.
9. Upon completing all sections, review the document for accuracy, then save the changes. You can choose to download, print, or share the form as required.

Complete your documentation online today for a smoother and more efficient process.