Please select a primary diagnosis before continuing.
Step 3
Secondary Diagnosis — Optional, for complex or multi-diagnosis care
๐ Locked for session
Step 4
Communication Status
๐ Locked for session
Please select communication status before continuing.
๐ฃ๏ธ
Speaking
Spoken words / phrases / sentences
๐ฌ
Non-speaking / AAC
Minimally speaking, AAC-supported, or non-speaking
"Speaking" = patient uses spoken words or phrases as primary communication. "Non-speaking / AAC" = minimally speaking, AAC-supported, or non-speaking. This shapes all output language and stays locked for the session.
Step 5
Additional Factors Optional — select all that apply
Step 6
Select ADL Area
Please select an ADL area before generating output.
๐ฟ
Bathing
๐งผ
Hygiene
๐
Dressing
๐ฝ
Toileting
๐ชฅ
Grooming
๐ฝ๏ธ
Feeding & Eating
๐ถ
Mobility
๐
Transfers
Neurotypical Expectation
What a child this age achieves without this diagnosis
Functional Ceiling
Maximum expected function with this diagnosis at this age
Step 7
Behaviors Associated with This ADL — optional, select all that apply
โฉ Select a new ADL area — patient setup stays locked. Repeat for each ADL needed.
๐ง Layer 1 — Global Disease Profile:
๐ Layer 2 — Milestone & Functional Ceiling: ·
Developmental Milestone
Child this age without this diagnosis
Functional Ceiling
Child with [diagnosis] at this age
Step 8
Observed Assist Level —
Supervision / Cueing
Physically able to participate — needs setup, step-by-step cueing, and safety supervision
Minimal Assist
Completes most tasks — needs light hands-on help for selected components only
Moderate Assist
Completes only part independently — needs hands-on help for a substantial portion
Maximum Assist
Participates in limited portions — needs extensive physical assistance for most steps
Total Dependence
Fully dependent — caregiver performs the complete routine
๐ ADL Function Grid — Authorization Summary Table
โ ๏ธ Safety Risk Documentation
๐งฌ Multi-Diagnosis Complexity Statement
๐ State Criteria Compliance Check
๐ Recertification Timeline & CMS-0057-F Notice
โฑ Hours Justification Statement
๐ Conservative Care & Lower Level of Care Justification
๐ Prior Authorization Letter — Complete Documentation Package
Appeal
Denial Response Generator
Assess another ADL for this patient?
Next ADL
Select Next ADL Area
๐ฟ
Bathing
๐งผ
Hygiene
๐
Dressing
๐ฝ
Toileting
๐ชฅ
Grooming
๐ฝ๏ธ
Feeding & Eating
๐ถ
Mobility
๐
Transfers
Neurotypical Expectation
What a child this age achieves without this diagnosis
Functional Ceiling
Maximum expected function with this diagnosis at this age