Eps download 2026

1. Click ‘Get Form’ to open the eps download in the editor.
2. Begin by filling out the Identifying Information section. Enter the applicant's name, MID#, address, and phone number. Indicate gender by selecting either Male or Female.
3. Complete the Responsible Party/Curator details, including their relationship to the applicant, address, date of birth, and contact numbers.
4. In the Medical Information section, provide details as required by the attending physician. This includes patient name, primary and secondary diagnoses along with their codes.
5. Fill in physical examination results and any special care/procedures needed. Check appropriate boxes for daily or PRN care requirements.
6. Document medications prescribed along with dosage and frequency in the designated fields.
7. For Activities of Daily Living, indicate the level of assistance required for each task based on your assessment using the provided guide.
8. Finally, ensure that a physician's order is completed at the end of the form, including their signature and date.

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