ATTACHMENT G
ATTENDANT CARE CHECKLIST
Where the response is 'YES' go to the next point.
Where the response is 'NO' complete the point before proceeding further.
1.Has a claim been made by the employee for attendant care services?
YES — q — NO — q
2.What is the nature and extent of the employee's condition? Is he or she severely incapacitated or impaired?
YES — q — NO — q
3.Have all the following issues been addressed:
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whether rehabilitation has been, or is being, undertaken;
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the personal care tasks required and the nature and degree of injury precluding the employee from undertaking such tasks him or herself;
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any nursing or other medical care currently assisting with the employee's personal needs;
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whether household members and/or relatives are reasonably able to assist with some or all of the employee's particular personal needs;
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the likelihood that use of attendant care services would preclude the employee from needing to be maintained in a nursing home environment; and
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whether provision of services would assist to maintain the employee in current employment, or assist him or her to return to employment?
YES — q — NO — q
4.Are the services being claimed reasonable?
YES — q — NO — q
5.Are the cost and amount of time for each service being claimed also reasonable?
YES — q — NO — q
6.Have you considered how long services are being approved for?
YES — q — NO — q
7.If not, have you issued a letter to be completed by the employee and his or her treating doctor or rehabilitation provider?
YES — q — NO — q
8.Have you clearly advised the employee and Case Manager in writing about:
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the agreed amount of time services are approved for;
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specific services to be undertaken;
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the amount of hours per week for services; and
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the cost of services?
YES — q — NO — q
9.Have you clearly noted on PRACSYS, under the 'CCOM.CM' function (category 'R' and code 'HAC') what has been approved, how long approval is provided for and the specific services and costs approved?
YES — q — NO — q