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DOH
The DOH Form refers to a form issued by the New York State Department of Health (DOH). In the context of Medicaid and long-term care services, the DOH is responsible for administering various health-related programs, including Medicaid, Managed Long-Term Care (MLTC), and Home and Community-Based Services.
NYIA Form
The NYIA Form refers to forms and documentation related to the New York Independent Assessor (NYIA) program, which is used for Medicaid Long-Term Care (MLTC) assessments in New York State.
The NYIA program is responsible for conducting independent functional assessments of individuals applying for or receiving Medicaid-managed long-term care services. The goal of the NYIA is to evaluate the individual’s functional needs and determine eligibility for Medicaid services like home health care, nursing facility care, or other long-term care services.
Pre Employment Physical Form
A Pre-Employment Physical Form is a medical assessment required by employers before hiring a candidate to determine their fitness for the job and ensure they are in good health to perform the required duties. This form is often used to screen candidates for jobs that involve physical labor or working in environments where health and safety are crucial.
Yearly Physical Form
A Yearly Physical Form is a medical document that is used to record a comprehensive physical examination of a patient that is typically done once a year. It is commonly used by physicians to assess the overall health of a patient and to track any changes in their medical status over time. This form is often required by insurance companies, schools, sports teams, or employers to ensure that a person is in good health.
M11Q Form
The M11Q Form is a Medical Request for Home Care used in New York State, specifically for Medicaid applicants seeking Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS). The form is used to assess whether a patient is eligible for home care services based on their medical condition and functional needs.
Doctors Note & Certificate
A doctor’s note (also known as a sick note or medical note) is a written statement provided by a healthcare professional that certifies a patient’s health status. It typically outlines that the patient was seen by the doctor, the nature of their condition, and may include recommendations or restrictions.
Plan of Care - 485
CMS-485 (Home Health Certification and Plan of Care) is a Medicare-required document used by home health agencies to outline a patient’s care plan and certify their eligibility for home health services. It ensures proper documentation for Medicare and Medicaid reimbursement.
Face to Face Referral Form
The Face-to-Face (F2F) Referral Form is a Medicare-mandated document that certifies a patient’s eligibility for home health services. It confirms that a physician (or an allowed non-physician practitioner) has evaluated the patient in person and determined they require home health care.
Telehealth Visit Notes
Televisit notes are clinical documentation created by a healthcare provider after conducting a telehealth or virtual appointment with a patient. These notes summarize the patient’s condition, medical history, assessment, and treatment plan based on the remote visit.
Regular Tele Visit
A Regular Televisit is a scheduled virtual medical consultation between a patient and a healthcare provider using video and/or audio technology. It allows patients to receive medical care remotely without visiting a clinic or hospital.

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