Dma 3000-2025

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The document is a comprehensive Physician Authorization for Certification and Treatment (PACT) form used for Personal Care Services (PCS). It includes sections for patient information, assessment of activities of daily living (ADLs), current care, medications, cognitive skills, safety assessments, and a plan of care. The form aims to evaluate the patient's needs for personal care services based on their medical condition and to certify the necessity of such services by the attending physician.

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