PAE Transition Review Worksheet Actual Date of Transition OCC Placement OCC choices_ transitions @uhc.com ICC Two Manager Other HCBS benefits CIC Assignment TN Facility Comprehensive Visit Assessment FOC Transition Unit False OCC All Initial NF Visit Requirements PYC Email all forms PASRR Outcome Assignment in ICUE PAE Cert Form ICC STS Ten True Cancel Services Assignment Alternate Mailing Address MCM Approval Thirty Alternate Primary Address Unsuccessful NF Visit MOPD CD Withdrawal Form TF F2F Orders for admission LOC Hand Off of Cases SOP Request to Transition Between CHOCES Groups (TF) Level 2 TN PAE Certification Form Group 3 and Group 2G PAE Transition Review Worksheet Actual Date of Transition OCC Placement OCC choices_ transitions @uhc.com ICC Two Manager Other HCBS benefits CIC Assignment TN Facility Comprehensive Visit Assessment FOC Transition Unit False OCC All Initial NF Visit Requirements PYC Email all forms PASRR Outcome Assignment in ICUE PAE Cert Form ICC STS Ten True Cancel Services Assignment Alternate Mailing Address MCM Approval Thirty Alternate Primary Address Unsuccessful NF Visit MOPD CD Withdrawal Form TF F2F Orders for admission LOC Hand Off of Cases SOP Request to Transition Between CHOCES Groups (TF) Level 2 TN PAE Certification Form Group 3 and Group 2G
(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.
PAE Transition Review Worksheet
Actual Date of Transition
OCC
Placement
OCC
choices_ transitions @uhc.com
ICC
Two
Manager
Other HCBS benefits
CIC Assignment
TN Facility Comprehensive Visit Assessment
FOC
Transition Unit
False
OCC
All Initial NF Visit Requirements
PYC
Email all forms
PASRR Outcome
Assignment in ICUE
PAE Cert Form
ICC
STS
Ten
True
Cancel Services Assignment
Alternate Mailing Address
MCM Approval
Thirty
Alternate Primary Address
Unsuccessful NF Visit
MOPD
CD Withdrawal Form
TF
F2F
Orders for admission
LOC
Hand Off of Cases SOP
Request to Transition Between CHOCES Groups (TF)
Level 2
TN PAE Certification Form
Group 3 and
Group 2G