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FOR BHF USELL1
2021STATE OF ILLINOIS
DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
FINANCIAL AND STATISTICAL REPORT (COST REPORT)
FOR LONGER CARE FACILITIES
(FISCAL YEAR 2021)
I.DPH License ID Number:
Facility
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How to fill out promedica skilled nursing ah
How to fill out promedica skilled nursing ah
01
Obtain a copy of the Promedica Skilled Nursing AH form.
02
Fill out the resident's personal information including name, date of birth, address, and phone number.
03
Provide details about the resident's medical history and current medications.
04
Include information about any special dietary restrictions or allergies.
05
Provide contact information for the resident's primary care physician.
06
Sign and date the form, indicating your relationship to the resident if applicable.
07
Review the completed form for accuracy before submitting it to the healthcare provider.
Who needs promedica skilled nursing ah?
01
Individuals who require skilled nursing care in a Promedica facility.
02
Patients who have complex medical conditions that require continuous monitoring and treatment.
03
Residents who need assistance with activities of daily living such as bathing, dressing, and medication management.
04
Those who may benefit from rehabilitation services following surgery or illness.
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What is promedica skilled nursing ah?
Promedica skilled nursing ah is a form used to report skilled nursing facility services provided by Promedica.
Who is required to file promedica skilled nursing ah?
Skilled nursing facilities under the Promedica network are required to file promedica skilled nursing ah.
How to fill out promedica skilled nursing ah?
Promedica skilled nursing ah can be filled out by providing details of services provided, patient information, and any other required data.
What is the purpose of promedica skilled nursing ah?
The purpose of promedica skilled nursing ah is to accurately report and document skilled nursing services provided by Promedica facilities.
What information must be reported on promedica skilled nursing ah?
Information such as service dates, patient demographics, service codes, and any other relevant details must be reported on promedica skilled nursing ah.
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