Hcfa 487 Form PDF Details

In the realm of healthcare administration, meticulous documentation serves not just a bureaucratic purpose but plays a critical role in ensuring the continuity and quality of patient care. The HCFA-487 form, approved by the Department of Health and Human Services and under the purview of the Health Care Financing Administration (now known as the Centers for Medicare & Medicaid Services), embodies this principle. This addendum to the plan of treatment and medical update document assists in the systematic monitoring of a patient's medical care, ensuring that the treatment provided aligns with the evolving needs of the patient. It contains key identifiers such as the patient's Health Insurance Claim Number, Social Security commencement date, certification period, medical record number, and provider number, thereby providing a comprehensive overview of the patient's treatment journey. Alongside these identifiers, the form also records the names of the patient and the provider, item numbers relevant to the treatment, and requires the signatures of the involved physician, and optionally, that of a nurse or therapist. These fields collectively facilitate a detailed and organized approach to patient care management, which is pivotal in administering effective and timely medical interventions.

QuestionAnswer
Form NameHcfa 487 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescms 487 blank, hcfa 487 form, printable hcfa form, form 487 fillable

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Department of Health and Human Services

Form Approved

Health Care Financing Administration

OMB No. 0938-0357

ADDENDUM TO:

 

 

PLAN OF TREATMENT

 

MEDICAL UPDATE

 

 

 

 

 

 

 

 

 

1.

Patient’s HI Claim No.

2. SOC Date

3. Certification Period

 

4. Medical Record No.

5. Provider No.

 

 

 

 

From:

To:

 

 

 

6.

Patient’s Name

 

 

 

 

7. Provider Name

 

 

 

 

 

 

 

 

 

 

 

 

 

8.Item.

No.

9. Signature of Physician

10. Date

11. Optional Name/Signature of Nurse/Therapist

12. Date

Form HCFA-487 (U4) (4-87)

PROVIDER

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Writing section 1 of addendum plan

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Stage number 2 in completing addendum plan

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