<p> CM-04A INSTRUCTIONS 04/13</p><p>CASE MANAGEMENT FOLLOW-UP DOCUMENTATION CONTINUED FORM INSTRUCTIONS FOR COMPLETION</p><p>This is an optional supplemental page which, if used, must be attached to a completed CM-04 Follow-up form. The case manager must sign and date the CM-04 that accompanies this form. </p><p>If you are using the electronic version of the CM-04, it will allow space to continue typing information and therefore, this form would not be necessary. </p><p>NAME: enter the client’s first and last name. MEDICAID NUMBER: enter the client’s Medicaid number. If the client’s Medicaid is pending, enter “pending”. CONTINUATION OF FOLLOW UP NUMBER: check box for the appropriate follow-up number.</p><p>SUMMARY OF FOLLOW-UP CONTACT CONTINUED Document continuation of the activities that occurred during the follow-up contact. </p><p>1</p>