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PRINTED: 11/04/2024 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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Gather all necessary personal and organizational information.
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Identify the specific objectives and outcomes you wish to measure.
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The Burke ICF (Individualized Care Form) is a document used to provide detailed information about an individual's care needs and preferences in the healthcare system.
Individuals seeking personalized care services or organizations providing such services are typically required to file a Burke ICF.
To fill out the Burke ICF, one must provide detailed personal information, medical history, care preferences, and any specific needs or goals that should be addressed.
The purpose of the Burke ICF is to ensure that care providers have a comprehensive understanding of an individual's care requirements to tailor their services appropriately.
The Burke ICF must report details such as personal identification, health conditions, medications, care goals, and specific support needed in daily activities.
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