Communication to Physician 2025

1. Click ‘Get Form’ to open the Communication to Physician document in the editor.
2. Begin by entering the Physician Name and Clinic Address at the top of the form. This information is essential for proper communication.
3. Fill in the Recipient Name and Date of Birth (DOB) in the designated fields. Ensure accuracy as this identifies the patient receiving PCA services.
4. Indicate the Diagnosis and date of assessment for PCA services. This provides context for the physician regarding the patient's needs.
5. Select whether the person meets access criteria for PCA services by checking the appropriate box. If eligible, specify minutes or hours per day of service required.
6. Detail any dependencies in Activities of Daily Living (ADLs) by checking relevant boxes such as Dressing, Grooming, or Mobility.
7. If applicable, note any complex health-related needs like Tube Feeding or Wounds in their respective sections.
8. Finally, complete any referrals needed for additional services and ensure all contact information is filled out accurately before saving your document.

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