Appointment
Sheet Instructions
Introduction
An
Appoinment Sheet is a monthly listing of
Medicaid-approved children assigned to a specific
provider who are due for a HealthCheck exam. The sheet
is sent to each provider so that the child can be
scheduled and the results of the exam recorded and
returned to HealthCheck staff.
HealthCheck
is responsible for reporting the numbers of children who
have received HealthCheck exams to the Centers for
Medicare & Medicaid Services, (CMS), formerly known
as HCFA.
The
Appointment Sheets provide HealthCheck with the
most current and accurate information regarding the
status of each child.
Sample
Appointment Sheet
Instructions
on completing the Appointment Sheet
Information
on completing each appointment sheet is contained at the
bottom of each sheet. Providers are requested to record the
following in the last 3 columns:
Actual
Exam Date
Result
"K" for Kept Appt., "C" for Cancelled
Appt., and "M" for Missed Appt.
Referrals
& Comments - Referrals, including physician name,
and date scheduled must be recorded so that HealthCheck can
track the services the child receives.
At
the end of each month, this information should be returned to
the HealthCheck Family Outreach Worker whose name and address
appears at the bottom of the Appointment Sheet. If an
appointment sheet has not been returned to the Family Outreach
Worker and the Family Outreach Worker has no other means of
determining whether the child received a HealthCheck exam, the
names of the children on that sheet must be carried over to
the next month's appointment sheet.
Need
Help?
Contact
your Program Specialist. Find the number in the OUTREACH
section of this website. Or call:
HealthCheck
1-800-642-9704
Return
to HealthCheck Home Page
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