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PRINTED: 09/20/2024 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION

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How to fill out a paper follow-up was

01

Gather necessary information such as patient details, previous visit notes, and treatment recommendations.

02

Check the fields on the form that need to be completed for the follow-up.

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Fill in the patient's name, date of birth, and contact information at the top of the paper.

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Enter the details of the previous appointment including date and reason for the visit.

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Document the current symptoms or test results relevant to the follow-up.

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Patients who have undergone a previous medical procedure or treatment and require monitoring.

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