Center Street Promenade Anaheim, CA 92805 7147129500 ADDENDUM to Physician Face to Face Encounter Document Examples: Discharge Summary, Progress notes, History and - stjosephhomehealth 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the patient's name, date of birth (DOB), and start of care (SOC) in the designated fields.
  3. In section one, check the appropriate boxes for services ordered and provide a detailed explanation for each service based on clinical findings.
  4. In section two, certify that you have had a face-to-face encounter with the patient by filling in the date of this encounter.
  5. For section three, detail the reasons why the patient is homebound. Complete all boxes regarding conditions, assistive devices used, and effort required to leave home.
  6. Ensure you sign and date at the bottom of the form. Print your name and include your primary care physician's name as well.
  7. Finally, fax the completed form to the provided numbers for submission.

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