Forms and Documents

Forms for Prospective and Existing Clients

  • Documentation of Face to Face Encounter for MEDICAID Patients - The purpose of this form is to comply with Home Health Services: Section 6407(b) of the Affordable Care Act (ACA) and implementing federal regulations require that no payment may be made by a state Medicaid Program for home health services, unless the prescribing physician documents that the physician or NPP had a face-to-face encounter with the MA beneficiary. The face-to-face encounter must be related to the primary reason the MA beneficiary requires home health services. The face-to-face encounter must occur within 90 days prior to or 30 days after the initiation of home health services, although it is expected that ordinarily the face-to-face encounter will occur prior to the start of services. The federally authorized NPPs able to perform face-to-face encounters for nursing, home health aide, physical therapy, occupational therapy, speech pathology and audiology services are: PAs, CRNPs, CNMs and CNSs. 

  • Minnesota Living Will Brochure

  • Intake Request Form - Please Note: An intake request that is filled out and faxed to us is not an acknowledgement of any acceptance of services until approved by Director of Nursing.

  • Home Care Bill of Rights

Forms For Prospective Employee's

Equity Services is an Equal Opportunity Employer. 

Nondiscrimination statement :

Equity Services of St Paul Inc.  complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.