- Title the document as “Face-To-Face”
- Include the name of the patient
- Include the date of encounter
- Include all clinical information to support the need for skilled nursing and/or therapy services
- Include information to support homebound status
- Include dated signature of certifying physician
*Reminder: There must be TWO dates on the form-one is the date that the encounter occurred and the other is the date that the physician signed the document. The two dates may be the same, or they may be different.