
Day Tuesday Wednesday Thursday Date→ Tasks: Indicate Tasks Completed Each Day by Signing with Worker’s Initials. Eating Bathing Dressing Grooming Transferring Ambulation Toileting Light Housekeeping Food Preparation & Storage Shopping Laundry Medication Reminders Assist to Scheduled Medical Appointment Assist to Arrange Medical Transportation Accompany to Medical Appointments Friday Saturday PARTICIPANT/RESPONSIBLE REPRESENTATIVE/LEGAL REPRESENTATIVE’S SIGNATURE:________________________.
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How to fill out the LA OAAS-PF-10-010 online
This guide provides clear and concise instructions for completing the LA OAAS-PF-10-010 form online. Designed for users with varying levels of experience, this resource will help you navigate each section with confidence.
Follow the steps to successfully complete the LA OAAS-PF-10-010 form.
- Select the ‘Get Form’ button to access the form in your online environment.
- Begin by entering the provider's name in the designated field. Ensure that the name is spelled correctly.
- Next, print the name of the Direct Service Worker in the appropriate field to ensure clear identification.
- Input the participant's full name in the section provided to document who is receiving services.
- Enter the participant's date of birth in the specified format to verify their age.
- Fill in the beginning date of the prior authorization week, starting on Sunday.
- Complete the ending date of the prior authorization week, noting the Saturday date.
- For each day of the week listed, fill in the applicable dates for the services provided.
- Each day, the Direct Service Worker must initial next to each task performed to indicate completion.
- At the end of the week, obtain the signature of the participant or their responsible representative, along with the date of signature.
- Have the Direct Service Worker sign and date the form, confirming that all services for that week have been delivered.
- Duplicate the second page if additional documentation is necessary, and complete the progress notes for that week.
- Document any changes in the participant's condition in the progress notes, including any deviations from the plan of care.
- Finalize each page of the progress notes with the necessary initials and dates from both the participant and the Direct Service Worker.
- Lastly, note the total number of pages used at the bottom of each section to maintain accurate records.
- Once completed, save, download, or print the form for your records.
Start filling out the LA OAAS-PF-10-010 form online today to ensure efficient documentation of personal care services.
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