DMAS 99 Wizard
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Section 1 of 8: 1) Visit Type / Header
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1) Visit Type / Header
2) Member + Provider Identification
3) Functional Status
4) Medical / Nursing Information
5) Support System
6) Service Facilitator / RN / LPN Supervision
7) Consistency and Continuity
8) Authorization / Closing / Signatures
1) Visit Type / Header
Assessment Date
Program Type
Agency-Directed Services
Consumer-Directed Services
Visit Type
Initial Visit
Routine Visit
Six-Month Re-assessment
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