Locus worksheet pdf 2021-2026

1. Click ‘Get Form’ to open the locus worksheet PDF 2021 in the editor.
2. Begin by entering the 'Date of Assessment' at the top of the form, ensuring it reflects the date you completed the assessment.
3. Fill in the 'Recipient Date of Birth' using the format MM/DD/YYYY, and select 'Male' or 'Female' for 'Recipient Gender'.
4. Provide either the Recipient PMI or Social Security Number, with a preference for PMI.
5. In the 'Diagnosis' section, write in the full name of the primary diagnosis or include its ICD code.
6. For each dimension evaluated (Risk of Harm, Functional Status, etc.), check the appropriate rating and document any criteria used for scoring on the line provided.
7. Calculate and enter your 'Composite Score' by summing up scores from all dimensions.
8. Complete fields for Provider Name, NPI, Service Type, and specify both 'Level of Care Recommendation' and 'Actual Level of Care Provided'.
9. Document any services referred to in the designated section.
10. Finally, sign and date where indicated. If applicable, have a clinical supervisor sign as well.

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