List the amount Number of days Total Non-Skilled Service Components. of time required service will be minutes To be completed by the member Describe CDAC Provider Activity as allowable by each day for provided per for the or legal representative. the Iowa Administrative Code. each activity. month. line. member’s N8 Financial and scheduling 0 includes money assistance – management, cognitive tasks, and scheduling personal business matters. N9 Assistance in the workplace 0 – assistance with self-care tasks, environmental tasks, and medical supports necessary for the member to perform a job. Assistance with understanding and completing essential job functions is not included. N10 Communication includes 0 – interpreting, reading services, assistance with communication devices, and supports that address the unique member’s communication needs. This does not include reading mail, newspapers or helping the member 'talk' to friends. N11 Essential transportation 0 – assisting or accompanying the member in using transportation essential to the health and welfare of the member. N12 Medication assistance includes 0 – assisting the member in sorting, storing, organizing, and taking medications ordinarily It also includes medication equipment maintenance and medication administration. Member Name:
Non-Skilled Service Components. To be completed by the member or member’s legal representative. Describe CDAC Provider Activity as allowable by the Iowa Administrative Code. List the amount of time required each day for each activity. Number of days service will be provided per month. Total minutes for the line. N8 Financial and scheduling assistance – includes money management, cognitive tasks, and scheduling personal business matters. 0 N9 Assistance in the workplace – assistance with self-care tasks, environmental tasks, and medical supports necessary for the member to perform a job. Assistance with understanding and completing essential job functions is not included. 0 N10 Communication – includes interpreting, reading services, assistance with communication devices, and supports that address the member’s unique communication needs. This does not include reading mail, newspapers or helping the member 'talk' to friends. 0 N11 Essential transportation – assisting or accompanying the member in using transportation essential to the health and welfare of the member. 0 N12 Medication assistance – includes assisting the member in sorting, storing, organizing, and taking medications ordinarily It also includes medication equipment maintenance and medication administration. 0 Member Name:
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