Fillable DMA 6, Physicians Recommendation Concerning Nursing Facility Care

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What Is DMA 6 Form?

Also known as Physicians Recommendation Concerning Nursing Facility Care, it’s a document that provides a physician’s confirmation of a person’s need for nursing facility care. The form is a must-complete when it comes to the nursing home applicants with Medicaid coverage. Find the Georgia DMA-6 form here on PDFLiner, download it or fill it out online via our website.

DMA 6 Physicians Recommendation Concerning Nursing Facility Care Screenshot

What the DMA 6 form is used for

The sheet is used for:

  • confirming the patient’s overall condition and diagnoses;
  • verifying that the patient in question needs nursing home care.

As for the pre-structured template of the DMA 6 form Georgia, its purpose is to save loads of your treasured time and help you shape the form in the most accurate and effective way possible. Healthcare providers should fill out the form and file it to the patient’s preferred nursing home.

How to Fill Out the DMA 6 Form

In a nutshell, the form provides the physician’s professional assessment in writing for the purpose of verifying that the patient’s nursing facility of choice is their most-suitable care option. Here’s a brief step-by-step guide on how to complete the form:

Additionally, this section should also contain ID details about the physician, such as their name, address, licensure number, and phone number.

  1. Provide the patient’s and facility’s ID info, such as:
    • facility’s name and address;
    • facility type;
    • patient’s Medicaid number;
    • their SSN;
    • patient’s full name, age, gender, and location;
    • admission date;
    • facility from which the person is being moved;
    • date and signature.
  2. Provide the details of the physician’s examination report and recommendations, such as:
    • diagnosis on admission to the facility;
    • treatment plan;
    • hospital diagnosis;
    • medications;
    • diagnostic and treatment procedures;
    • recommendations concerning level of care considered necessary;
    • period of time care needed.
  3. Evaluate in writing nursing care needed based on the following criteria:
    • diet;
    • bowel;
    • overall condition;
    • mental and behavior status;
    • bladder;
    • hours out of bed;
    • therapy types & their weekly frequency.
  4. Specify the patient’s impairments based on the following parameters:
    • sight;
    • hear;
    • speech;
    • paralysis.
  5. Specify the patient’s daily living activities based on the following criteria:
    • eats;
    • wheelchair;
    • transfers;
    • bath;
    • ambulation;
    • dressing.
  6. Don’t forget to add the signatures and current data.

How to Write the DMA 6 Form

There’s no universal answer to this question, because doctor’s recommendations regarding nursing homes vary depending on the patient’s needs and circumstances. One major go-to recommendation is to ensure the form is clear and accurate. Avoid any miscommunication let alone factual mistakes or typographical errors. As a physician, don’t forget to add your contact information. The recipient may need it in case they have any questions.

Who should sign the DMA-6 form Georgia

The form should be signed by the responsible physician and the patient in question (if they are able). To speed up the process, give our e-signature tool a try. Digital signatures save tons of your precious time and allow you to send docs for signatures to any of your contacts, with the chance for an instant reply! This is something you can never achieve if you send files for signature via regular mail. So, try PDFLiner and you’ll absolutely love online file management.

Organizations that work with the form

  • Division of Medical Assistance;
  • healthcare facilities.

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