3. The current Skilled Nursing Facility (SNF) face sheet is :
4. Dates of Service
6. Days of the week transported to above appointment(s)
7. Is Documentation Attached?
10. The prescribed treatment plan including problems, interventions, and goals (along with why original goals were not met, if this is a reauthorization TAR)
11. Patient mobilizes via:
13. Based on 11 and 12, above, the required mode of transport is:
