Nursing Addendum to POC.doc 2026

1. Click ‘Get Form’ to open the Nursing Addendum to POC.doc in the editor.
2. Begin by entering the client’s name, Medicaid number, and date at the top of the form. This information is crucial for identification and processing.
3. Complete the Documentation Requirements section by checking off each item that applies, ensuring all necessary documents are included for review.
4. In the Nursing Care Plan Summary section, outline the problem list, goals of care, specific measurable outcomes, and progress toward those goals. This provides a comprehensive overview of the client's needs.
5. Fill out the Summary of Recent Health History with any relevant medical updates or changes in condition that may affect PDN services.
6. Detail the Rationale for PDN Hours based on current needs and any plans for adjustments in service hours.
7. Complete the Schedule of Services sections by accurately documenting coverage using military time. Ensure all resources are accounted for.
8. Finally, gather signatures from all required parties in the Acknowledgement section to confirm understanding and agreement with the plan of care.

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