Get Oh Odm 10227 2018-2026

The OH ODM 10227 form is essential for facilities seeking to participate in the Ohio Department of Medicaid Nursing Facility Ventilator Program. This guide provides a comprehensive walkthrough to help users complete the form online effectively.

Follow the steps to fill out the OH ODM 10227 form with ease.

1. Press the ‘Get Form’ button to access the OH ODM 10227 form and open it in the editing environment.
2. Begin by filling out the facility name, city, zip code, tax identification number, county, and Medicaid number in the designated fields.
3. Input the room and bed numbers in the ventilator unit as required.
4. For each requirement listed, check ‘Yes’ or ‘No’ to confirm if the facility meets the standards for ventilator connectivity, availability of respiratory care professionals, registered nurses, therapy assessments, laboratory services, and pain medication administration.
5. Complete the section for requesting approval to participate in the vent weaning part of the program by checking ‘Yes’ or ‘No’ based on your facility’s capabilities.
6. If applicable, indicate if the program requirements were met as of the date of a change in operator (CHOP). Provide the date if requirements were not met.
7. Enter the name, title, email address, and phone number of the person completing the form.
8. Specify the requested effective date for participation and provide your signature along with the date of completion.
9. After you have filled out all necessary sections, save your changes. You may then download, print, or share the completed form as needed.

Complete your OH ODM 10227 form online to ensure your facility's participation in the program.