Printable healthcare 487 med quest 1994 form-2025

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The document is a Home Health Certification and Plan of Care form approved by the Department of Health and Human Services, specifically for use by the Centers for Medicare & Medicaid Services. It outlines essential patient information, medical diagnoses, treatment plans, and safety measures necessary for providing home health care services. The form also includes sections for physician certification, patient prognosis, and legal disclaimers regarding the accuracy of provided information.

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Click ‘Get Form’ to open the printable healthcare 487 med quest 1994 form in the editor.
Begin by entering the Patient's HI Claim No. and Medical Record No. in the designated fields at the top of the form.
Fill in the Start Of Care Date and Certification Period, ensuring you specify both start and end dates.
Complete the Patient's Name, Address, Date of Birth, and Sex fields accurately to ensure proper identification.
In sections for medications, list any new or changed medications along with their dose, frequency, and route.
Provide details for ICD-9-CM diagnoses and surgical procedures as required in their respective fields.
Address safety measures, nutritional requirements, and allergies to give a comprehensive overview of patient needs.
Finally, ensure that all signatures are completed where necessary before saving or printing your filled form.

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Versions	Form popularity	Fillable & printable
2014	4.4 Satisfied (52 Votes)
1994	4.3 Satisfied (27 Votes)

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