Personal Care: place the total time for each task, for each day. Write the amount of time for each task to the nearest 15 minutes.
Level of Care: enter a score for each activity of daily living (ADL) based on the participant's current functioning.
Service Authorization: Service Authorization (SA) must be obtained prior to initiating a change outside the authorized LOC category.
Signature: the participant's signature is required on all plans of care.
Respite plans: the LOC score is not required for respite plans of care.
| Question | Answer |
|---|---|
| Form Name | DMAS 97 A/B |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 223 |
| Avg. time to fill out | 38 min |
| Other names | DMAS 97 A/B, DMAS 97A/B, DMAS-97A/B, DMAS 97 AB, DMAS 97, Provider Plan of Care Virginia |
| Edition | Rev 8/2026 |
| Official source | DMAS 97A/B Revised 8/2026 |
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