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DHSDD812 Provisional Plan of Care Name of person receiving services: Medicaid #: Case Manager Name: Funding: HUBS Child HUBS Adult CTS Is this an enhanced rate? Yes No Is the participant transitioning
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How to fill out provisional plan of care

01
To fill out a provisional plan of care, follow these steps:
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Start by gathering all relevant information about the patient, such as their medical history, current condition, and any prescribed medications.
03
Identify the specific goals and objectives of the provisional plan of care. These can include improving the patient's condition, managing symptoms, or promoting overall well-being.
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Consider the patient's individual needs and preferences when creating the plan. It should be tailored to their unique situation and take into account any cultural or personal factors.
05
Develop a detailed schedule outlining the specific care activities and interventions that will be implemented. This can include medication administration, therapy sessions, regular check-ups, and any necessary precautions.
06
Clearly document the responsibilities of each healthcare professional involved in the patient's care. This can include doctors, nurses, therapists, and support staff.
07
Review the provisional plan of care with the patient and their family members, ensuring that they understand the goals, activities, and potential outcomes. Address any questions or concerns they may have.
08
Obtain the necessary signatures and approvals from the patient, their legal guardian (if applicable), and any other relevant parties involved in their care.
09
Regularly evaluate and update the provisional plan of care as needed, based on the patient's progress and changing needs. It should be a dynamic document that reflects the evolving nature of the patient's condition.
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Remember to always adhere to any legal and ethical guidelines when creating and implementing a provisional plan of care.

Who needs provisional plan of care?

01
A provisional plan of care is typically needed for patients who require ongoing healthcare services or support. This can include individuals with chronic illnesses, patients recovering from major surgeries or injuries, elderly individuals with complex health needs, and those undergoing rehabilitation or therapy.
02
The provisional plan of care helps to ensure that the patient's healthcare needs are properly addressed, coordinated, and monitored. It serves as a roadmap for healthcare professionals involved in the patient's care, guiding them in delivering the appropriate treatments, interventions, and services.
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The provisional plan of care is a temporary care plan put in place until a more permanent plan can be established.
The healthcare provider or caregiver responsible for the patient's care is required to file the provisional plan of care.
The provisional plan of care can be filled out by documenting the patient's current medical condition, treatment plan, and any other necessary information.
The purpose of the provisional plan of care is to ensure that the patient's immediate needs are met until a more comprehensive care plan can be developed.
The provisional plan of care should include the patient's medical history, current medications, treatment goals, and any special instructions for care.
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