Delaware's Division of Medicaid and Medical Assistance uses this one-page physician report to decide whether a long-term care applicant meets nursing home level of care, in a facility or in the community. The physician summarizes history, current impairments, test results, diagnoses, prognosis and treatment. It is returned with the Pre-Admission Evaluation to the long-term care medical eligibility unit.
The physician completes the whole report, from measurements and history to progress, then signs, dates and marks whether the applicant meets a nursing home level of care.
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Comprehensive Medical Report (A)
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The report ends with a yes or no box: whether the applicant meets a nursing home level of care for care in a facility or in the community. DMMA's reviewer uses the physician's history, findings, diagnoses and prognosis to determine long-term care medical eligibility.
The form asks for objective findings, including X-rays, lab and diagnostic test results with dates, and allows a separate sheet when space runs out. It is returned together with the Pre-Admission Evaluation, whose skilled services must be supported by physician orders.