Make a decision
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Does your patient safely leave home
frequently for non-medical purposes?
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Leave home to participate in
therapeutic,psychological or
medical treatment in an adult
day care program, licensed or
certified by the state
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YES
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NO
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Not considered Homebound
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Does your patient require assistance
when leaving home?
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The use of a cane, wheelchair or assistance to leave the home
• A limited ability for ambulation due to pain and/or weakness
• Severe heart disease in a patient who must avoid stress
• A physician has determined outings are medically
contraindicated
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YES
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NO
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Requires the assistance of another person
• May require the use of a cane, walker or wheel chair
• Limited ability to walk due to pain or weakness
• A psychiatric condition that manifests with a refusal to leave
home or that makes it unsafe to leave home unattended
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Does your patient endure considerable
and taxing effort when leaving home?
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Patient not considered homebound
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YES
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Patient is considered Homebound
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Homebound Status Determination
