This patient is under my care. I have established a plan of care, and it will be reviewed by the physicians periodically. I have authorized the home health services. I refer to MedSide Healthcare and certify, that based on my findings, the following services are medically necessary
Criteria 1: Homebound Reason
The aid of supportive devices such as:
I certify that this form was completed based on a face-to-face encounter that meets the physician face-to-face requirements. The form was completed by a physician based on a face-to-face encounter or information provided by a nurse practitioner, physician’s assistant, certified nurse midwife, or clinical nurse specialist working in conjunction with the certifying physician or physician who cared for this patient in an acute or post-acute facility.