SERENITY HOME HEALTH CARE LLC 2026

1. Click ‘Get Form’ to open the SERENITY HOME HEALTH CARE LLC document in the editor.
2. Begin by entering the patient's name in the designated field, followed by their date of birth (DOB) and social security number (SSN). Ensure accuracy for proper identification.
3. Fill in the patient's phone number to facilitate communication. Next, provide the physician's name, address, and contact information, ensuring all details are complete for seamless coordination.
4. Select the services required by checking the appropriate boxes for Skilled Nurse Visit, Physical Therapy, Occupational Therapy, Speech Therapy, or Home Health Aide Services.
5. In the 'Other requested orders' section, specify any additional services needed. This ensures comprehensive care tailored to your patient’s needs.
6. The nurse should sign and date at the bottom of this section to validate the order before submission.
7. For physician use only: Fill in primary and other diagnoses along with their corresponding ICD 9 codes. The physician must then sign and date this section before faxing back to initiate services.

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