Agency Schedule Detail

Authorization Number : 50750066

Agency Series No. : 500-00-15

Status : Active

Agency Web Link :

Agency : ODM

Confidential Description : Contains patient specific personal and health related information.

Division : ODMHINQ

Vital Description :

Section : ODMHINQ

Record Title : Private Duty Nursing (PDN) Authorization and Administration Files

Revision : 1

Record Description : Record contains, but not limited to, request for PDN Prior Authorization(form ODM 02374), assessments, acuity tool, prior authorizations, all supporting back up documentation, denial decisions, hearing notices and decisions, appeals summaries, PDN consumer case files, and reimbursement decisions.

Retention Period	Retention Justification	Media Code	Method of Disposal
Retain 3 years in office, 4 years in records center, then destroy providing all audits are complete.	OAC 5101:3-12-02 OAC 5101:3- 02-03 OAC 5101:3-12-04 OAC 5101:3-12-06	Paper	Shred

Approvals

Status	Name	Title	Date
Approved	Dennis Hawk	Records Coordinator	2/14/2019 1:50:00 PM
Approved	Lisa Stafford	Records Officer	2/14/2019 2:14:00 PM
Approved	Terri Dittmar	Record Administrator	2/15/2019 1:25:00 PM
Approved	Fred Previts	State Archivist	2/20/2019 10:50:00 AM
Approved	Martin Meeks	State Auditor	2/28/2019 9:24:00 AM

Notes

Date	Reason	User