Question Samples - KEPRO / DMAS Home

Question Samples - KEPRO / DMAS Home

INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT Home Health Questionnaire Presented To: Home Health Providers May 2015

Home Health Questionnaire When initiating the Home Health questionnaire, you will see the question Are you requesting an evaluation? Answering Yes leads to the question Is there a Physicians order signed and dated by the Physician for the evaluation? The second question is Are you requesting home health visits? When you

answer Yes, this will open up a series of questions requiring answers in order to complete the questionnaire. Examples follow in the next five slides. All questions require completion for successful submission 2 Question Samples

Drop Down Menus on select questions: Question Samples

B-12 injections Question Samples Speech/Swallowing Therapy:

Question Samples Skilled Nursing question:

Question Samples Indwelling catheters: Home Health Questionnaires

If you have any questions or concerns regarding completion of the questionnaires ,please contact KEPRO at 1-888-827-2884

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