Canada Life requires a pre-care assessment to set how much private nursing care a group benefit plan will cover, and this form should be submitted before nursing care begins. After review, Canada Life contacts the provincial home care case coordinator and tells the claimant in writing what coverage, if any, applies and the number of eligible hours.
The patient's physician completes Part 2 (current medical information), printing clearly. The plan member completes Part 1, the provincial home care case coordinator or manager completes Part 3, and the plan member and patient sign Part 5.
Download the current version from the source each time; forms change without notice.
Nursing Care Health Assessment Form
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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Before nursing care begins. Canada Life requires a pre-care assessment to establish the amount of nursing care covered under the group plan, and it asks that the form be completed in full and sent before care starts. Incomplete forms delay the assessment.
Part 2 offers RN, RPN/LPN and HCA/PSW levels, noting coverage is based on plan design. For RN or RPN/LPN care, the physician must specify the nursing treatments, such as dressings or injections, with frequency and length, and these cannot be duties an HCA or PSW could perform.
Not the plan. The completion instructions state that fees for providing medical information are not payable by the plan, so any physician fee for Part 2 is not reimbursed under the group benefit plan.