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Enter information for the physician signing the order. Enter either the physician’s license number as issued by the New York State Department of Education or the provider billing number issued by the New York State Department of Health Medicaid Management Information System.
DOH-4359 (2010) PHYSICIAN’S ORDER FOR PERSONAL CARE/CONSUMER DIRECTED PERSONAL ASSISTANCE SERVICES. COMPLETE ALL ITEMS INCOMPLETE FORMS WILL BE RETURNED TO THE PHYSICIAN. 1. Patient Identifying Information (Use Additional Paper If Necessary) 2. General Information. 3. Medical Findings.
fax the completed form to 718-907-3377. If you have any questions call 718-736-2344 and ask to speak with our Intake Department. TIPS ON HOW TO ACCURATELY COMPLETE THE (DOH-4359)
Download the DOH-4359 Physician's Order for Personal Care/Consumer Directed Personal Assistance Services form in PDF and Word formats. Fill it online and save as a ready-to-print PDF for free.
In September, 2009, State DOH issued a revised Form DOH-4359, which is the standardized Physician’s Order for Personal Care Services for use in the Personal Care Services Program (PCSP) and the Consumer Directed Personal Assistance Program (CDPAP).
As of May 16, 2022, the NYS DOH has rolled out several significant modifications to the PCS and CDPAS assessment process: 1. DOH-4359 Form Replacement: Individuals aged 18 and above are no longer mandated to submit the DOH-4359 form during the initial assessment phase.
This document provides a physician's order form for personal care and consumer directed personal assistance services. It includes sections for patient identifying information, general physician and examination information, medical findings including diagnoses, condition stability, treatment plan, functional limitations, medication information ...