West Palm Beach: 561-964-6767
Boynton Beach: 561-733-2331
Criteria for Chart Notes for Group 1 Support Surfaces:
▢ The examination occurred within 6 months prior to the date of the written order.
▢ The examination documents that the beneficiary was evaluated and/or treated for a condition that supports the need for a group 1 pressure reducing support surface.
Medical Justification Indicated in Chart Notes: (Beneficiary must meet 1 of the following)
▢ 1) The beneficiary is completely immobile -i.e., beneficiary cannot make changes in body position without assistance, -OR-
▢ 2) The beneficiary has limited mobility -i.e., beneficiary cannot independently make changes in body position significant enough to alleviate pressure, & at least one of the conditions A-D below:, -OR-
▢ 3) The beneficiary has any stage pressure ulcer on the trunk or pelvis, & at least one of conditions A-D below:
Conditions: (one or more must be indicated for Medical Justification 2 or 3 listed above)
• Impaired nutritional status
• Fecal or urinary incontinence
• Altered sensory perception
• Compromised circulatory status
Conditions for criteria 2 and 3 (in each case the medical record must document the severity of the condition sufficiently to demonstrate the medical necessity for a pressure reducing support surface):
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