VA DMAS-97A B 2019-2025-2025

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VA DMAS-97A B 2019-2025 Preview on Page 1

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  1. Click ‘Get Form’ to open the VA DMAS-97A B 2019-2025 in the editor.
  2. Begin by entering participant and provider information at the top of the form, including Medicaid ID# and Provider ID#.
  3. In the 'Categories/Tasks' section, check off each activity of daily living (ADL) performed throughout the week. Record total time for each day.
  4. Complete the 'Special Maintenance' section by indicating any additional services required, such as vital signs or wound care, and total maintenance time.
  5. Fill out the 'Supervision Time' and 'IADLS' sections, detailing tasks like meal preparation and laundry, ensuring to sum up total times accurately.
  6. Calculate and enter the composite ADL score based on participant performance in each category to determine level of care.
  7. Finally, ensure all signatures are obtained where necessary before saving or exporting your completed form.

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