Nursing Addendum to Plan of Care (CCP) 1 of 10 - TMHP.com 2026

1. Click ‘Get Form’ to open the Nursing Addendum to Plan of Care in the editor.
2. Begin by entering the client’s name, Medicaid number, and date at the top of the form. This information is crucial for identification and processing.
3. Complete the Prior Authorization Request Submitter Certification Statement by checking 'We Agree' after reading the terms. Ensure that all information provided is accurate and complete.
4. Fill out the Documentation Requirements section, ensuring all necessary documents are listed and attached as needed for review.
5. In the Nursing Care Plan Summary section, outline the problem list, goals of care, specific measurable outcomes, and progress toward those goals.
6. Provide a summary of recent health history detailing any hospitalizations or changes in condition that may affect care.
7. Detail the rationale for PDN hours requested, indicating whether they will increase, decrease, or remain unchanged.
8. Complete the Schedule of Services sections by filling in military time slots with caregiver codes for each day of the week.
9. Finally, ensure that all signatures are obtained from clients/parents/guardians and nurse providers in the Acknowledgement section before submitting.

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