2. Skilled-nursing justification

• Skilled assessment documented — findings with clinical reasoning, not just “WNL.”
• Skilled intervention(s) performed and described.
• RN-level reasoning explicitly stated — why the service was not unskilled.
• Quantified patient response — numeric pre/post values, stated against the ordered parameter or the specific prior value rather than “baseline.”
• Medical Necessity Sentence present — skilled action + RN-level reason + measurable effect.