Get Homemaker/personal Care Documentation Sheet

The Homemaker/Personal Care Documentation Sheet is essential for documenting the services provided to individuals receiving personal care assistance. This guide will help you complete the form online accurately and effectively, ensuring all necessary information is submitted.

Follow the steps to fill out the Homemaker/Personal Care Documentation Sheet

1. Click 'Get Form' button to obtain the document and open it in the online editor.
2. in the 'Name of provider' field, enter your name or the name of the provider delivering the service.
3. In the 'Name of Individual receiving service' section, provide the full name of the person receiving care.
4. Fill in the 'DODD Contract Number' with the appropriate contract information related to the services.
5. Enter the 'Medicaid number of individual' in the specified field to ensure proper service tracking and billing.
6. Complete the 'DODD ISP Span Year' with the correct year related to the Individual Service Plan.
7. Sign the 'Signature of Provider' section to confirm that you have provided the services according to the Individual Service Plan (ISP).
8. Select the 'Type of Service' from the options provided: either Routine HPC or HPC/OSOC.
9. Document the 'Date of Service' to reflect when the services were provided.
10. In the 'Place of Service' field, indicate where the services were delivered.
11. Provide a detailed 'Description of service' as specified in the ISP, outlining the nature of the assistance given.
12. Indicate the 'Group Size' if applicable, stating how many people were receiving services if in a group setting.
13. Record the 'Time in (Begin Time)' and 'Time out (End Time)' to document the duration of services provided.
14. Fill in the 'Number of units of service' to reflect the amount of care provided according to the billing requirements.
15. Use the 'Notes' section to add any additional information or relevant comments about the service delivered.
16. After reviewing all fields ensure accuracy, choose to save your changes, download your completed form, print it, or share it as necessary.

Complete your Homemaker/Personal Care Documentation Sheet online to ensure effective record-keeping and compliance.