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Complex Medical Needs in Children: Resources for Health Care Providers

The faculty and staff of the Beacon Program at Children’s Mercy have compiled a list of resources for health care providers when caring for pediatric patients with complex medical conditions. Resources include order forms, sample letters, documentation and contact information. 

Request a consultation at the Beacon Clinic


We hope to be of service to you and your patients in the near future. To request a consultation for a patient, please visit our Provider Portal and click on Beacon Clinic or complete this form. Requests for consultation should be made by a primary care provider. 

Access our consultative services


The Beacon Program provides consultative services that allows children with medical complexity can receive quality care while staying close to home. 

Resources for providers

 

Video resources

How-To Guide for Writing Durable Medical Equipment (DME), Nursing Orders

 

Provider documentation for DME and supply needs

Need to be included in your documentation to secure DME or patient supplies

Catheters: If not seen recently by Urology, Kidney, Nephrology Clinics

  • If in diapers with catheterization, why the need for both

  • Current condition relating to Catheters and diapers

  • Current Cath schedule and indication

  • Diapers for used mainly for urination or stooling

Need to be included in your documentation to secure DME or patient supplies

Cough Assist Device:

  • Diagnosis of Neuromuscular Disorder, SMA or Quadriplegia

  • Weak Cough

  • Poor Muscle tone

Need to be included in your documentation to secure DME or patient supplies

Diapers: Needs evaluated yearly

  • Mental capacity ex: severely, moderately developmentally delayed

  • Physical condition ex: contractors with severity, wheelchair dependent, mobility ex: ability to set, stand etc.

  • The need for diapers (incontinent and their ability to be toilet trained)

  • List of their diagnosis

  • Number used per day

Pull ups: Needs evaluated and documented every 6 months for progress 

  • The need for pull ups

  • List of their diagnosis

  • Number used per day

  • The progress with toilet training

  • Document they are participating in toilet training

  • The ability to independently care for their toileting needs

Need to be included in your documentation to secure DME or patient supplies

Formula:

  • What kind of formula and feeding schedule

  • PO or g-tube

  • Will need evaluated by Nutrition within one year

Need to be included in your documentation to secure DME or patient supplies

Hospital bed: 

  • Indication for hospital bed

    • Need for HOB elevated greater than 30 degrees

    • Rapid change in position or frequent body position changes

    • Assist with transfer from bed to wheelchair (pt has to be able to assist with transfer)

  • Have pillows/wedges been tried, if so why did they not work

  • Respiratory issues that require the HOB to be elevated

Need to be included in your documentation to secure DME or patient supplies

Oxygen: Needs evaluated every 90 days for oxygen need

  • Liter flow per min with the Lowest to start at and Highest liter flow for patient to use before seeking care

  • Condition relating to oxygen

  • Will need a current oxygen saturation on room air

  • Need 87% or below documented in the 90 days for initial and recertification for oxygen

Need to be included in your documentation to secure DME or patient supplies

Pulse Oximeter:

  • For Medicaid both Missouri and Kansas, oxygen needs to be in the home for Medicaid to pay

Need to be included in your documentation to secure DME or patient supplies

Suction:

  • Need to make note of increased secretions

  • If risk for aspiration

Need to include the following information when ordering thickener from DME:

Thickener: 

  • A current OT or SLP Feeding evaluation (noting thickener recommendation)

  • Type of Thickener needed  (Simply Thick Gel (can be used with ketogenic diets), Hormel Thick and Easy, Thick it/Thick up powder, Gel Mix)

  • Consistency needed (ie nectar, honey, syrup thickness)

  • Amount of thickener needed per month

  • Amount of liquid needed per day and food(s) that need to be thickened

  • OT and/or SLP notes with VFSS (Videofluoroscopic swallow study) results within the prior year

 

Order forms

Enteral order form

You will need to fill out the following on the Enteral order form:

  • Documentation noting the need for the Feeding Pump or gravity feeding
  • Patient demographics
  • Feeding Pump (if indicated)
  • Feeding Bags
    • either 500ml or 1200ml
    • Disp: 30 per month
  • Extension Sets
    • Continuous 12” or 24”
    • Bolus 12” or 24” (used with gravity feedings and 60ml syringes)
    • Disp: 4 per month
  • Syringes
    • Either 10, 15, 20, 35 or 60cc
    • Disp: 4 per month
  • Mickey Button or NG Tube
    • Size
    • Disp: Mickey Button – 1 every 90 days
      NG – 2 per month
  • Formula – See Formula Section

Respiratory order form

Beacon-Private duty nursing or private duty care assistant form

Urological order form

Other order form

 

Sample letters of medical necessity

 

Kansas and Missouri

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