Recommend or describe action taken to eliminate the hazard, unsafe condition or practice. (If corrective action has been taken, indicate the date of abatement.)

Condition Code 44 will not affect payment. It will be used for monitoring purposes only to allow CMS and Quality Improvement Organizations (QIOs), to track and monitor these occurrences.

A primary diagnosis by a licensed physician (or designee as defined in program rules) of a related condition may be required to meet eligibility for the following Medicaid programs:

Describe in detail patient’s current medical condition(s) and diagnosis. Give specific information to support the Department’s action. NO 1. Is this patient able to safely operate a motor vehicle at …

By signing this form, you confirm the patient has been diagnosed with one or more of the following severe or disabling chronic conditions.

Hopefully, answering these questions for your facility will help you meet the rule requirements for responding to changes of condition. Good luck! participation!

Complete the move-in section of this form and return it to your Landlord within the time required by your lease. All items are presumed to be in good condition unless noted otherwise. Test all …