Monthly Care Summary Logo
  • Virginia Birth-Related Neurological Injury Compensation Program 

    Monthly Care Summary

  • (Must be submitted at the end of each month with timesheets)

  • General Information:

  • List medications and times given: (Only list each medication once and the time(s) of day normally given. This is not a daily list, just a general description of medications and times given.) 

    To start--> Start typing on the open spaces in this table to start listing each medication. If you need more space for any category, please attached a second page (Upload in the Add Files here through drag/drop or Upload from your computer or portable device).

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  • Personal care given (checkbox, circle method or fill in the blank):

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  • Every * hours

  • Status:

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  • Skin Condition:

  • List of equipment being used:

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  • If you need more space for any category above, please attach (upload) a second page. Upload the document in PDF(scanned file) or JPG (photo image) into the link below. Any comments for Nurse Case Manager? 

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  • Submit Instructions: To finalize your submission, you have three options.

    1 - Preview PDF - Review the draft version and save as a PDF or print a copy.

    2. Save and Continue Later - Save your draft submission for up to 90 days. Once you click this button, you will receive an email with a link to return at a future time. 

    3. Submit - Click this button if you are ready to submit. 

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