Community Health Support Program (CHSP) forms for the CHSP RN Provider
The following forms are required for use by the CHSP RN Provider to document and communicate client summary information to the case manager. These forms are not intended to meet or replace documentation requirements set forth in Oregon nursing law and professional practice standards.
RN Provider documentation forms are for use by CHSP RN Providers for their Medicaid clients only! Use of the forms outside of the CHSP is prohibited.
||SPD Community Health Support Program RN Service Plan
||SPD Community Health Support Program RN Services Summary
|SPD Community Health Support Program forms for Case Managers and Service Coordinators|
||SPD Community Health Support Program Client Referral for Community RN Health Evaluation and RN Service Plan
|SPD Community Health Support Program forms for Prior Authorization of Ongoing CHSP RN Provider Services and Payment Authorization of Client Re-evaluation|
||Case Manager Prior Authorization for SPD Contract RN (Monitoring Visit, Delegation/Teaching Non-Family, Teaching Family)
||Case Manager Payment Authorization for SPD Contract RN (Reassessment)