Moments Intake

BWBernard WilliamsonNew ReferralMoments St. Paul11open

Confirm terminal diagnosis & prognosisT-8D95

Obtain face-to-face encounter documentationT-DA5B

Verify hospice eligibility against LCD criteriaT-F6CE

Verify Medicare eligibilityT-C120Auto

Identify POA / healthcare proxyT-0744Auto

Confirm hospice election form on fileT-AECA

Obtain consent-to-treat signatureT-A41C

Assign admitting nurseT-4117

Schedule admission visitT-2720

Confirm service address in coverage areaT-1BBD

Notify referral source of acceptanceT-14C6

PDPatrick DonnellyNew ReferralMoments Minneapolis10open

Confirm terminal diagnosis & prognosisT-1984

Obtain face-to-face encounter documentationT-E878

Verify hospice eligibility against LCD criteriaT-04EC

Identify POA / healthcare proxyT-1561Auto

Confirm hospice election form on fileT-A427

Obtain consent-to-treat signatureT-C491

Assign admitting nurseT-D91C

Schedule admission visitT-85EE

Confirm service address in coverage areaT-D141

Notify referral source of acceptanceT-ACCB

JCJermiah CorianderNew ReferralMoments Minneapolis10open

Confirm terminal diagnosis & prognosisT-D3A6

Obtain face-to-face encounter documentationT-5E44

Verify hospice eligibility against LCD criteriaT-7AB7

Identify POA / healthcare proxyT-8B2CAuto

Confirm hospice election form on fileT-60CE

Obtain consent-to-treat signatureT-B436

Assign admitting nurseT-F15B

Schedule admission visitT-8AE4

Confirm service address in coverage areaT-14E5

Notify referral source of acceptanceT-C50A

SPSanji PatelNew ReferralMoments St. Paul10open

Confirm terminal diagnosis & prognosisT-01F5

Obtain face-to-face encounter documentationT-C2CC

Verify hospice eligibility against LCD criteriaT-DF3F

Identify POA / healthcare proxyT-EFB4Auto

Confirm hospice election form on fileT-1433

Obtain consent-to-treat signatureT-5F29

Assign admitting nurseT-2A29

Schedule admission visitT-C1B7

Confirm service address in coverage areaT-4169

Notify referral source of acceptanceT-567A

MSMargaret SullivanNew ReferralMoments Minneapolis9open

Confirm terminal diagnosis & prognosisT-A524

Obtain face-to-face encounter documentationT-0008

Verify hospice eligibility against LCD criteriaT-1C7B

Confirm hospice election form on fileT-F66F

Obtain consent-to-treat signatureT-C14C

Assign admitting nurseT-BBA3

Schedule admission visitT-2086

Confirm service address in coverage areaT-AB95

Notify referral source of acceptanceT-E7F4

JWJenny WangIn ProgressMoments Minneapolis7open

Obtain face-to-face encounter documentationT-A4F1

Confirm hospice election form on fileT-3095

Obtain consent-to-treat signatureT-AA66

Assign admitting nurseT-331B

Schedule admission visitT-5AAB

Confirm service address in coverage areaT-A3E0

Notify referral source of acceptanceT-06CA

POPatrick O'BrienIn ProgressMoments Minneapolis6open

Verify hospice eligibility against LCD criteriaT-6328

Confirm hospice election form on fileT-C636

Obtain consent-to-treat signatureT-4884

Schedule admission visitT-F04C

Confirm service address in coverage areaT-3A91

Notify referral source of acceptanceT-A635

PWPenelope WangIn ProgressMoments St. Paul5open

Confirm hospice election form on fileT-9107

Obtain consent-to-treat signatureT-41F9

Assign admitting nurseT-5064

Schedule admission visitT-BB1D

Notify referral source of acceptanceT-7CB5

WTWalter ThompsonReady to AdmitMoments St. Paul1open

Notify referral source of acceptanceT-EE8A

SKSanji KumarReady to AdmitMoments Minneapolis1open

Obtain consent-to-treat signatureT-ADAB

SHSally HuangReady to AdmitMoments Minneapolis1open

Notify referral source of acceptanceT-3E46

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