Get Pa Dhs Ma-51 2016-2025

Filling out the PA DHS MA-51 form is an essential step in the medical evaluation process for individuals seeking assistance. This guide provides detailed, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete your PA DHS MA-51 form online.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. At the top of the page, indicate whether this is a new or updated MA-51 by marking the appropriate box.
3. Complete questions 1-7, which are self-explanatory, including the applicant's name, age, sex, and attending physician.
4. Enter the physician license number in field 8; ensure it is the correct number, not the medical assistance number.
5. In field 9, specify where the evaluation took place by entering the code from 1 to 5, and provide a description if using code 5.
6. For field 10, the applicant should sign if able; if not, a legal guardian or responsible party may sign on their behalf.
7. Provide essential vital signs in field 11, including height, weight, temperature, blood pressure, pulse rate, and cardiac rhythm.
8. Summarize important medical information in field 12, including known allergies.
9. Indicate how much assistance the patient requires to vacate the building in field 13, selecting from the provided options.
10. In field 14, state if the patient can self-administer medications.
11. Complete field 15 with ICD diagnostic codes, listing them first in the blocks and then writing their corresponding names.
12. Detail professional and technical care needs in field 16, checking each applicable category.
13. In field 17, outline physician orders and associated treatments, ensuring they match the care needs indicated.
14. Indicate the patient’s prognosis in field 18, checking the appropriate box.
15. In field 19, assess rehabilitation potential, ensuring it aligns with the prognosis.
16. Complete field 20A by providing the physician’s recommendation for the level of care needed.
17. If applicable, complete section 20B to indicate the discharge expectations based on the current prognosis.
18. Field 20C requires the physician to sign and date the MA-51.
19. Ensure fields 21 and 22 are completed by the OPTIONS Unit if necessary.
20. Once all fields are filled, save any changes, and download, print, or share the form as needed.

Complete your PA DHS MA-51 form online and ensure all necessary details are accurately filled out.