HCAI - Patient Management Program
Additional Comments
The Additional Comments tab is for attachment information if applicable or any other information to
support the treatment plan. Up to 20,000 characters can be used in this field.
Additional Buttons
Information regarding the buttons on the lower portion of the form can be found on page 21.
The signature on file and signature date boxes are required fields when sending forms electronically.
Signatures are not transmitted to the insurer; however, hard copies of the form must be printed and
signed and kept on file. To obtain signatures, the entire OCF should be completed. It is not advisable for
health professionals or claimants to sign incomplete forms.
Print the completed draft form and have the claimant sign it.
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