Revised Physician's Order for Personal Care Services
This file provides the revised DSS-4359 Physician's Order for Personal Care Services for use in the Personal Care Services Program (PCSP) and the Consumer Directed Personal Assistance Program (CDPAP). It includes details on completing the order and the changes made to the form. It is intended to assist local social services districts (LSSD) in obtaining physician’s orders for personal care services.
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How do I fill this out?
To fill out the revised Physician's Order form, you will need to provide specific information regarding the consumer's personal care needs. Use the instructions provided to complete each section of the form accurately. This process ensures that the necessary personal care services are properly documented and authorized.
How to fill out the Revised Physician's Order for Personal Care Services?
1
Download the DOH-4359 form.
2
Fill out the consumer's personal information.
3
Complete the medical sections based on the physician’s observations.
4
Record the nurse assessor's home visit observations.
5
Submit the completed form to the appropriate LSSD.
Who needs the Revised Physician's Order for Personal Care Services?
1
Local District Commissioners need this file to authorize personal care services.
2
Medicaid Directors use this file to ensure proper documentation for PCSP and CDPAP.
3
Physicians need this form to verify consumer’s need for personal care services.
4
Nurse Assessors use this file to record observations from home visits.
5
LSSD use this form to maintain records and ensure compliance with regulations.
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What are the instructions for submitting this form?
Submit the completed DOH-4359 form to your local social services district (LSSD). Contact the Personal Care Services Program Liaison at (518) 474-5888 for submission details. Forms can be sent via email, fax, or physical mail as instructed by your LSSD.
What are the important dates for this form in 2024 and 2025?
Key submission deadlines for 2024 and 2025 will be determined by individual LSSD guidelines. Always verify deadlines with your local district to ensure timely submissions.
What is the purpose of this form?
The purpose of the revised Physician's Order form is to ensure accurate documentation and authorization of personal care services for consumers in both the Personal Care Services Program (PCSP) and the Consumer Directed Personal Assistance Program (CDPAP). This form is essential for local social services districts (LSSD) to verify and approve the need for personal care services. By standardizing the information collected, the form helps maintain compliance with regulatory requirements while streamlining the assessment and authorization process.
Tell me about this form and its components and fields line-by-line.
- 1. Consumer Information: Includes personal details of the consumer such as name, address, and contact information.
- 2. Physician's Assessment: Contains medical observations and verification of the need for personal care services.
- 3. Nurse Assessor's Observations: Documents findings from the nurse’s home visit and assessment of the consumer’s functional abilities.
- 4. Return Details: Specifies the contact information for where the completed form should be returned to.
- 5. Additional Notes: Allows for any extra information the physician may want to include based on their knowledge and observations of the consumer.
What happens if I fail to submit this form?
Failing to submit this form may result in delays or denial of personal care services for the consumer.
- Service Delays: Without the proper documentation, approval and start of services may be postponed.
- Denial of Services: Incomplete or unsubmitted forms can lead to the denial of necessary personal care services.
- Regulatory Non-Compliance: Failure to submit the form as required can result in non-compliance with regulatory guidelines and potential penalties.
How do I know when to use this form?
- 1. Initial Assessment: Used during the initial assessment to verify the need for personal care services.
- 2. Renewal Assessment: Required for periodic reassessments to continue authorization of services.
- 3. Service Adjustment: Needed when there are changes in the consumer’s condition affecting their service needs.
- 4. Documentation Updates: Used to update records with new information from the physician or nurse assessor.
- 5. Regulatory Compliance: Ensures all personal care services documentation conforms to state regulations.
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