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Electroconvulsive Therapy (ECT) Authorization for Procedure: Continuation/Maintenance Treatment I, hereby authorize Dr. and any associates or assistants the doctor deems appropriate, to perform Electroconvulsive
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How to fill out bhs-136 ect continuation-maintenance authorizationdoc
How to fill out bhs-136 ect continuation-maintenance authorizationdoc:
01
Start by entering the patient's personal information, including their full name, date of birth, address, and contact information.
02
Next, provide the patient's medical information, such as their diagnosis, current medications, and any allergies they may have.
03
Indicate the type of electroconvulsive therapy (ECT) continuation or maintenance treatment being authorized by checking the appropriate box or providing a description if necessary.
04
Specify the frequency and duration of the requested ECT continuation or maintenance treatment.
05
If applicable, document any other treatments or therapies the patient may be receiving in conjunction with ECT.
06
Make sure to include the name and contact information of the treating physician responsible for administering the ECT.
07
Review the authorization form for accuracy and completeness before signing and dating it.
08
Provide any additional documentation or information requested by the form, if necessary.
Who needs bhs-136 ect continuation-maintenance authorizationdoc:
01
Patients who have been receiving electroconvulsive therapy (ECT) and require authorization for continuation or maintenance treatment.
02
Individuals who have undergone ECT as part of their mental health treatment plan and need to extend their treatment course.
03
Healthcare providers or facilities that offer ECT and require proper documentation and authorization to continue or maintain the therapy on their patients.
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