Get the free Psychiatric Inpatient (Extended) Request Form.fm - TMHP.com

Psychiatric Inpatient (Extended) Request Form 12357-B IATA Trace Parkway, Suite 150 Austin, Texas 78727-6422 I. Identifying information: Phone: 1-800-213-8877 Fax: 1-512-514-4211 Medicaid #: Last

How to fill out psychiatric inpatient extended request

How to fill out psychiatric inpatient extended request:

1. Begin by obtaining the necessary form from the relevant mental health institution or healthcare provider.
2. Carefully read the instructions and guidelines provided with the form to ensure accurate completion.
3. Fill in the patient's personal information, including their full name, date of birth, and contact details.
4. Provide details about the patient's current mental health condition, including any diagnosed disorders or symptoms experienced.
5. Indicate the reason for requesting an extended stay in an inpatient psychiatric facility, such as the need for continued observation or intensive treatment.
6. Include any relevant medical history, medications, or previous treatments received relevant to the patient's mental health condition.
7. Provide information about the patient's current supporting healthcare professional or psychiatrist, including their contact details.
8. If applicable, include any additional documents or reports that support the need for an extended inpatient stay.
9. Review the completed form for accuracy and ensure all sections are filled out correctly.
10. Submit the filled-out form to the designated department or individual, following the instructions provided.

Who needs psychiatric inpatient extended request:

1. Individuals who have been admitted to an inpatient psychiatric facility and require a longer stay beyond the initially assigned period.
2. Patients who need continued monitoring and treatment for a severe mental health condition that cannot be adequately addressed through outpatient care.
3. Individuals who require intensive therapy or specialized treatment that can only be provided in an inpatient setting.
4. Patients whose mental health has significantly deteriorated and necessitates a lengthier recovery period with constant support and supervision.
5. Individuals who may pose a risk to themselves or others and need a controlled environment for their safety and the safety of others.
6. Patients who have not shown significant improvement or stabilization in their mental health during their initial inpatient stay.
7. Individuals with complex mental health conditions that require additional assessment, consultation, and treatment options available in an inpatient setting.

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What is psychiatric inpatient extended request?

Psychiatric inpatient extended request is a formal request to extend the period of inpatient psychiatric care for a patient beyond the initially authorized period.

Who is required to file psychiatric inpatient extended request?

The healthcare provider or the authorized representative of the patient is required to file the psychiatric inpatient extended request.

How to fill out psychiatric inpatient extended request?

To fill out the psychiatric inpatient extended request, one needs to provide the necessary patient information, medical history, reason for extension, and any supporting documentation as required by the healthcare facility.

What is the purpose of psychiatric inpatient extended request?

The purpose of psychiatric inpatient extended request is to request an extension of the inpatient psychiatric care beyond the initially authorized period to ensure the patient receives adequate treatment and care.

What information must be reported on psychiatric inpatient extended request?

The psychiatric inpatient extended request must include the patient's personal information, medical history, current condition, reason for extension, supporting documentation, and any other relevant information requested by the healthcare facility.