Loading
Form preview picture

Get Oaas Pf 11 015 2021-2024

ADDITIONAL PAGES MAY BE USED. Page of Reissued November 6 2015 Replaces June 25 2015 Issuance OAAS-PF-11-015 Page 1 of 7 WEEK OF THROUGH DAILY SERVICES/SUPPORTS DESCRIPTIONS COMMENTS AND PROGRESS NOTES DAY OF WEEK AND DATE DESCRIPTIONS COMMENTS AND PROGRESS NOTES Instructions for Completion of Community Choices Waiver CCW Service Log The Community Choices Waiver CCW Service Log hereinafter referred to as the Service Log is used by CCW participants receiving Personal Assistance Services PAS. COMMUNITY CHOICES WAIVER CCW SERVICE LOG PROVIDER AGENCY NAME DIRECT SERVICE WORKER S NAME PARTICIPANT NAME PARTICIPANT DOB Week Of Day Of Week Date 1st Arrival Time w/ Initials 1st Departure Time w/ Initials 2nd Arrival Time w/ Initials 2nd Departure Time w/ Initials Through Sunday Monday Tuesday Wednesday Thursday Friday Saturday Indicate Task Completed Each Day W/Initials in Column for the Type PAS provided Tasks F O R A M P Eating Bathing Dressing Grooming Transferring Ambulation Toileting Light Housekeeping Food Preparation Storage Shopping Laundry Medication Reminders Assist To Sched Med Appts Assist To Arrange Med Trans Accompany To Med Appts Protective Supervision Supv/Assist w/Health Tasks Escort for Assist w/Comm Tasks Extension of Therapy Services Daily Total Of Hours WEEKLY TOTAL of Hours WEEKLY PAS for 1 HOURS WEEKLY PAS AM DSW SUPERVISOR S REVIEW SIGNATURE DATE Use of this line is optional NOTE DAILY SERVICES/SUPPORTS DESCRIPTIONS COMMENTS AND PROGRESS NOTES ARE TO BE RECORDED ON PAGE 2 OF THIS FORM. The Service Log is used to document weekly services under PAS including daily progress notes. NOTE Services provided by only ONE WORKER to ONE PARTICIPANT may be documented on a SINGLE SERVICE LOG* When an error is made only the individual who made the entry is allowed to correct the error. Corrections must be made by drawing a single line through the incorrect entry writing error above the entry initialing the correction and placing the correct information on the form* The use of carbon is permissible. It is also permissible for this form to be two-sided* The following instructions should be used to complete the Service Log PAGE 1 OF THE SERVICE LOG Items 1-7 are to be completed by the provider agency. It is permissible for this information to be typed onto the form* Enter the provider agency s name. NOTE For Self-Direction participants enter Self-Direction. Enter the name of the direct service worker. Enter the participant s name. WEEK OF THROUGH DAY OF WEEK SUNDAY MONDAY DATE TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY 1ST ARRIVAL TIME W/ SIGNED INITIALS 1ST DEPARTURE TIME W/ 2ND DEPARTURE TIME W/ Enter the beginning date of the prior authorization week example 9/06/15. Enter the ending date of the prior authorization week example 9/12/15. NOTE The prior authorization week begins on Sunday at 12 00 a*m* midnight and ends on the following Sunday at 12 00 a*m* midnight. For participants NOT in Self-Direction unused portions of the prior authorized weekly allocation MAY NOT be saved or borrowed from one week for use in another week.

How It Works

oaas 11 015 rating
4.8Satisfied
50 votes

Tips on how to fill out, edit and sign Reissued online

How to fill out and sign Sided online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Have you been trying to find a fast and convenient solution to fill in LA OAAS-PF-11-015 at an affordable price? Our service gives you a rich library of forms available for submitting online. It takes only a couple of minutes.

Keep to these simple actions to get LA OAAS-PF-11-015 prepared for sending:

  1. Find the form you need in our collection of legal templates.
  2. Open the template in our online editor.
  3. Read through the recommendations to discover which details you will need to provide.
  4. Select the fillable fields and include the required details.
  5. Add the date and place your e-autograph once you fill out all of the fields.
  6. Examine the completed form for misprints as well as other errors. In case there?s a necessity to correct something, our online editor as well as its wide range of instruments are ready for your use.
  7. Save the completed form to your device by clicking on Done.
  8. Send the electronic document to the intended recipient.

Filling out LA OAAS-PF-11-015 doesn?t need to be perplexing anymore. From now on simply cope with it from home or at the workplace right from your mobile device or personal computer.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Video instructions and help with filling out and completing oaas pf 015

Eliminate legal representative charges for acquiring and finishing your Form. Find all the tricks and tips you require in our video guide to start saving money on legal paperwork.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to LA OAAS-PF-11-015

  • PF
  • toileting
  • ADHC
  • DSWs
  • initialing
  • ambulation
  • CCW
  • issuance
  • reissued
  • dob
  • initialed
  • sided
  • applicable
  • CAREGIVER
  • Handwritten
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.