Get Or Exprs Plan Of Care - Service Delivery Report Form 2020-2025

Completing the OR EXPRS Plan Of Care - Service Delivery Report Form online is essential for documenting service delivery accurately. This guide will provide you with clear and concise steps to help you navigate and fill out the form effectively.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill out the 'Customer Name' field with the name of the person receiving services. Ensure the information is accurate to prevent any discrepancies.
3. Input the 'Month' and 'Year' of service in the provided fields, which helps track the services delivered during that specific timeframe.
4. Enter the 'Provider Name' and 'Provider Number.' This identifies the individual or organization delivering the services.
5. Specify the 'CDDP/Brokerage' as Resource Connections of Oregon, ensuring correct information is recorded.
6. Document the 'Service Authorized' and 'Service Delivered On' dates to maintain accurate records of the service provided.
7. Complete the 'SC/PA Name' field, which denotes the individual responsible for overseeing the care plan.
8. Indicate the 'Time Period' from the 1st to the 15th of the month or from the 16th to the end of the month based on when the services were provided.
9. Enter the 'Start/Time IN' and 'End/Time OUT' times for each session of service delivery in the specified AM or PM slots.
10. Calculate and input the 'Total Hours' served for the month by summing the hours from the time entries.
11. Detail the 'Service Goal' to describe the intent of the services provided.
12. Write 'Progress Notes' to summarize the measurable outcomes, and attach additional pages if more space is needed.
13. Obtain the 'Recipient/Employer Verification' signature, confirming the data reflects accurate service delivery.
14. The 'Provider/Employee Verification' section requires the signature of the provider, attesting to the authenticity of the reported hours worked.
15. Include the initials for authorization by the CDDP/Brokerage staff to enter the data into eXPRS for claims processing.
16. Finally, submit the completed and signed form to the appropriate CDDP or Brokerage that authorized the service delivery.

Begin completing your OR EXPRS Plan Of Care - Service Delivery Report Form online today for efficient documentation.