Texas Day Activity and Health Services (DAHS) providers send this form to a person's physician to obtain orders for initial DAHS approval, new orders after a change in condition, or supplemental orders for nursing services. The physician certifies that the person has a chronic medical condition requiring care, monitoring or intervention by a licensed nurse.
The DAHS provider completes Section I (the person's information and DAHS nurse) and sends a copy to the physician, who completes the rest: diagnoses with ICD-10 codes, functional limitations, diet, medications, treatments and the Section VI certification with signature, license and individual NPI.
Download the current version from the source each time; forms change without notice.
Physician's Orders (DAHS)
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That the person has a chronic medical condition requiring care, monitoring or intervention by a licensed nurse, that the primary diagnosis is not an intellectual or developmental disability or mental health condition, and that the physician is not an owner, partner or member of the requesting DAHS provider.
All medications given at home or by the DAHS provider, including as-needed over-the-counter drugs, with dosage, route, frequency and related diagnosis. The instructions include medications the person takes independently or with reminders, and ordered therapies or treatments with frequency.
Yes. Checking the box and dating it in Section VI certifies there is no significant change from the previous assessment. In that case the DAHS provider must also send the previous assessment when requesting authorization.