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Use of the Revised DMAS-90

Department of Medical Assistance Services. Use of the Revised DMAS-90. Provider Aide Record for Agency-Directed Personal and Respite Care. http://dmasva.dmas.virginia.gov. 1. Department of Medical Assistance Services. The following sections are unchanged: Individual Name Phone Date

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Use of the Revised DMAS-90

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  1. Department of Medical Assistance Services Use of the Revised DMAS-90 Provider Aide Record for Agency-Directed Personal and Respite Care http://dmasva.dmas.virginia.gov 1

  2. Department of Medical Assistance Services The following sections are unchanged: • Individual Name • Phone • Date • Activity • Daily Time In • Daily Time Out • Number of Hours All of this information is required. http://dmasva.dmas.virginia.gov 2

  3. The section for Weekly Comments or Observations has been revised to a checklist format. All questions must have ‘Y’ (Yes) or ‘N’ (No) checked. • If ‘Y’ is checked, there must be a comment/observation documented. • If ‘N’ is checked, no comment/observation is required.

  4. The questions/checklist has replaced the “Weekly Comments” section. It is expected the appropriate use of the checklist, including comments/ observations, will facilitate documentation as required by the Waiver regulations.

  5. New Questions: 1. Did you observe any change in the individual’s physical condition? This asks if the aide saw any changes in the individual’s health or body. Examples include: weaker; breathing heavier; diarrhea, etc. Also includes improvements such as: more energy; wound has healed; walking better, etc.

  6. 2. Did you observe any change in the individual’s emotional condition? This asks if the individual behaved differently. Examples include: crying; talking about being sad or angry; seeing things that aren’t there or smiling and laughing more; less confused, etc.

  7. 3. Was there any change in the individual’s regular daily activities? This asks if the care provided changed from the usual things that are done for the individual. Examples include: Refused bath or any other daily activity; eating more or eating less; walked further distance, etc.

  8. 4. Do you have an observation about the individual’s response to services rendered? This asks how the individual acted when the aide provided care. Examples include: said the bath made his skin itch less; feels better when turned, cried out when transferred from bed to chair, etc.

  9. Additional Comments/Observations (if needed): This space is for use if there is not enough space in the column for observations next to the ‘Y’ ‘N’ columns. If more space is needed, the back of the form may be used.

  10. The Weekly Signatures sections are unchanged.

  11. Questions on How to Use the Form? Contact your agency or the the DMAS Long-Term Care Division at 804-225-4222.

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