OMB No 0938-0357 HOME HEALTH CERTIFICATION AND PLAN OF-2026

1. Click ‘Get Form’ to open the OMB No 0938-0357 HOME HEALTH CERTIFICATION AND PLAN OF in the editor.
2. Begin by entering the Patient's HI Claim Number and Start of Care Date in the designated fields. This information is crucial for tracking patient care.
3. Fill in the Certification Period, ensuring that you specify both the start and end dates accurately to reflect the patient's care timeline.
4. Complete sections regarding the patient's personal details, including their name, address, date of birth, and sex. This ensures proper identification and record keeping.
5. Document all relevant medical diagnoses using ICD codes in the appropriate fields. This includes principal diagnosis and any other pertinent conditions.
6. Specify any durable medical equipment (DME) and supplies required for patient care, along with nutritional requirements as needed.
7. Review functional limitations and mental status sections carefully, providing accurate assessments to guide treatment plans.
8. Finally, ensure that all signatures are obtained where necessary, including those from healthcare providers and physicians before submitting the form.

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