Personal Care Services Forms for Kings
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FAQ
Once the determination of level of care is made, the physician will complete a document called an FL2. This is a one-page medical form that lists the physician's recommended level of care as well as medical diagnoses, care needs, and medications.
The completed signed M11Q Form should be sent within 30 calendar days after the medical examination to the following address: NYC HRA Home Care Services Program, Central Intake, 132 W. 125th St.,5th Fl., New York City, New York 10027.
Definition of Personal Care Services: Personal Care Services are a range of human assistance services provided to persons with disabilities and chronic conditions which enables them to accomplish tasks that they would normally do for themselves if they did not have a disability.
The doctor will complete a FL-2, this is North Carolina's form that describes a patient's medical condition and the amount of care they need when placed in a facility. A completed FL-2 form is required for Medicaid recipients admitted into any long term care facility.
What is personal care?Bathing and showering, including bed-baths.Applying lotions and creams as required.Dressing and getting ready for bed.Oral hygiene.Applying make-up, and hair care.Support with shaving.Foot care, especially if you are diabetic need to be extra vigilant with your feet.More items...?