Home Health/PCS/PPEC

• Reconsideration Review Request Form
• Reconsideration Review Request Form Instructions
• Request for Extension of Administrative Authorization of Services due to Fair Hearing

• Care Coordination Demographic Sheet
• Care Coordination PPEC/PDN Fax Request

• CDC+ Fax Request
• CDC+ Parent or Legal Guardian Medical Limitations
• CDC+ Parent or Legal Guardian School Schedule
• CDC+ Parent or Legal Guardian Work Schedule
• CDC+ Physician Order for Services
• CDC+ Physician Visit Documentation Form
• CDC+ Plan Of Care Form
• CDC+ Reconsideration Request
• CDC+ Required Supporting Documentation

• PDN/Parent or Legal Guardian Authorization Form
• PPEC Plan of Care Form
• PPEC Required Supporting Documentation

eQHealth Solutions works with Florida Medicaid and approves Private Duty Nursing care for children for meet clinical criteria. We want to make sure your child is receiving the services required to keep them safe in your home. We want to know if a provider does not meet the approved services. Here are ways to report any missed Private Duty Nursing shifts. Please contact us right away when a shift is missed.

Here are some ways to reach us:

1. Contact your Care Coordinator or Care Coordinator Supervisor
2. Call the toll-free number 1-833-321-7070.  The number is available 24 hours a day, 7 days a week.
3. Email flpdn@acentra.com.  This secure email address is available 24 hours a day, 7 days a week.

If you leave a voice message on the toll-free number or use the secure email address, please make sure to include your name and contact information as well as your child’s name.

If you have any questions or other concerns about Private Duty Nursing care for <Recipient First Name>, please contact your Care Coordinator or Care Coordinator Supervisor

• CMS 485 Plan of Care Form
• CMS 485 Plan of Care-Instructions
• Home Health Required Supporting Documentation
• Parent or Legal Guardian Medical Limitation Form
• Parent or Legal Guardian School Schedule Form
• Parent or Legal Guardian Work Schedule Form
• PCS Plan of Care Form-Unlicensed Independent
• PCS Required Supporting Documentation
• Physician Visit Documentation Form
• Physicians Order for Services Form
• POC Addendum Form