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Home Health Services
Forms

The following documentation requirement forms are included as appendices to the Florida Medicaid Home Health Services Coverage and Limitations Handbook . For provider convenience, these forms are also posted to the eQHealth Solutions, Inc. website beneath the Home Health/PCS/PPEC tab, Forms and Downloads.

Required documentation to be submitted with prior authorization requests

  • Physicians written prescriptions
  • Plan of care
  • Physician Visit documentation

Supporting documentation to be submitted with personal care service prior authorization requests

  • Parent/Legal Guardian Medical Limitations
  • Parent/Legal Guardian School Schedule
  • Parent/Legal Guardian Work Schedule