{"id":292,"date":"2014-06-06T15:53:02","date_gmt":"2014-06-06T15:53:02","guid":{"rendered":"http:\/\/homehealthstlouis.com\/?page_id=292"},"modified":"2014-06-23T12:08:09","modified_gmt":"2014-06-23T12:08:09","slug":"physician-face-to-face-reference","status":"publish","type":"page","link":"https:\/\/algonquinnursesstl.com\/physician-face-to-face-reference\/","title":{"rendered":"Physician Face-to-Face Reference"},"content":{"rendered":"[vc_row][vc_column width=&#8221;1\/1&#8243;]<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_chrome gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_5' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">CMS Home Health Physician Face-to-Face Encounter - Physician Face-to-Face Reference<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_5'  action='\/wp-json\/wp\/v2\/pages\/292' data-formid='5' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_5_4\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_4\" ><label class='gfield_label gform-field-label' for='input_5_4'>Patient Name<\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_5_4' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_5_5\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_5\" ><label class='gfield_label gform-field-label' for='input_5_5'>Home health start date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_5' id='input_5_5' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_5_5_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_5_5_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_5' class='gform_hidden' value='https:\/\/algonquinnursesstl.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_5_6\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_6\" ><label class='gfield_label gform-field-label' for='input_5_6'>Patient DOB<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_6' id='input_5_6' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_5_6_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_5_6_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_6' class='gform_hidden' value='https:\/\/algonquinnursesstl.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_5_8\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_8\" >1)\tI certify that I, or a nurse practitioner or physician's assistant working with me, had a Face to Face encounter with this patient on the date indicated below. This date needs to have occurred <u>within 90 days prior<\/u> OR <u>within the 30 days after<\/u> the Home Health episode start of care date.<\/li><li id=\"field_5_9\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_9\" ><label class='gfield_label gform-field-label' for='input_5_9'>Encounter date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_9' id='input_5_9' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_5_9_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_5_9_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_9' class='gform_hidden' value='https:\/\/algonquinnursesstl.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_5_10\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_10\" >2)\tThe encounter with the patient was in whole, or in part, for the following medical condition(s), which is the primary reason for home health care. <em><strong>Please list patient active diagnosis for home care:<\/strong><\/em><\/li><li id=\"field_5_11\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_11\" ><label class='gfield_label gform-field-label screen-reader-text' for='input_5_11'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_5_11' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_5_12\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_12\" >3)\tI certify that, based on my findings, the following services are medically necessary home health services and <em><strong>my clinical findings support the need for these services because:<\/strong><\/em><\/li><li id=\"field_5_13\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_13\" ><label class='gfield_label gform-field-label screen-reader-text' for='input_5_13'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_13' id='input_5_13' class='textarea medium'      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