Face To Face Encounter Form 2025

1. Click ‘Get Form’ to open the Face To Face Encounter Form in the editor.
2. Begin by entering the patient's name and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
3. In the section regarding the face-to-face encounter, specify the date when this encounter occurred. Use the format Month/Day/Year for clarity.
4. Indicate whether the patient requires intermittent skilled nursing care, physical therapy, speech therapy, or occupational therapy by checking the appropriate boxes or writing in details as needed.
5. Provide your signature and date in the certifying physician signature section. Make sure to print your name clearly below your signature for verification purposes.
6. Lastly, review any additional documentation that supports the patient's homebound status and need for skilled care, ensuring it aligns with CMS guidelines.

Start filling out your Face To Face Encounter Form online for free today!