Home Health Reports User Guide - CPSI Application Documentation

485, 486 and 487 Forms And Reports 35Listed below is an explanation of each column.Locator 1: Patient Claim # : Patient Referral Information page 3 contract numberLocator 2: Start of Care: Patient Evaluation Information page 1.Locator 3: Certification Period: Pulls from start of care date Patient Evaluation Information page1. Ending date is determined by the financial classLocator 4: Medical Record Number: Patient Evaluation Information page 2.Locator 5: Provider Number: Insurance Company Table page 1. Determined by patientsfinancial class.Locator 6: Patient Name/Address: Patient Referral Information page 1.Locator 7: Provider Name/Address: Physician “99999” Table page 1.Locator 8: Date of Birth: Patient Referral Information page 1.Locator 9: Sex: Patient Referral Information page 1.Locator 10: Medications: Certification Information section “2” Medications.Locator 11: ICD9 Principal Diagnosis: Plan Of Treatment/Medical Update section 1 "Diagnosis/Procedures".Locator 12: ICD9 Procedure: Plan Of Treatment/Medical Update section 1 "Diagnosis/Procedures".Locator 13: ICD9 Other Diagnosis: Plan Of Treatment/Medical Update section 1 "Diagnosis/Procedures".Locator 14: DME Supplies: Patient Referral Information page 2.Locator 15: Safety Measures: Plan Of Treatment/Medical Update section 3 "CertificationInformation" page 2.Locator 16: Nutritional Requirements: Plan Of Treatment/Medical Update section 3"Certification Information" page 2.Locator 17: Allergies: Plan Of Treatment/Medical Update section 3 "Certification Information"page 2.Locator 18A Functional Limitations: Plan Of Treatment/Medical Update section 3Certification Information page 1.Locator 18B Activities Permitted: Plan Of Treatment/Medical Update section 3 CertificationInformation page 1.© 2014 Computer Programs and Systems, Inc.