Physician Progress Note for Face to Face Encounter and Certification of Eligibility for Home Health Services (Per Medicare regulations, this form cannot be filled out by the home health agency or anyone with a financial relationship to the 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name, date of the face-to-face encounter, and date of birth in the designated fields.
3. In the section for the physician's information, print your full name and select your credentials from the options provided.
4. Document the medical diagnosis that necessitated the face-to-face encounter and any relevant findings from the patient encounter in both objective and subjective sections.
5. Indicate the patient's homebound status by selecting appropriate options based on their condition and provide detailed explanations where necessary.
6. Outline a comprehensive plan for skilled nursing, therapy needs, and any additional services required by checking relevant boxes and providing descriptions as needed.
7. Finally, sign and date the form at the bottom before saving or printing it for submission.

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