GA PSHP Intensive OutpatientDay Treatment Form free printable template

SUBMIT TO Utilization Management Department 1100 Circle 75 Parkway, Suite 1100 Atlanta, GA 30339 PHONE: 1,800. 947.0633 FAX 1.844.870.5064INTENSIVE OUTPATIENT/DAY TREATMENT FORM Please print clearly

How to fill out pshp - intensive outpatient

How to fill out GA PSHP Intensive Outpatient/Day Treatment Form

1. Gather patient identification information including name, date of birth, and contact details.
2. Provide insurance information if applicable, including policy number and provider.
3. Fill out the patient's medical history, including past treatments and current medications.
4. Include information about the patient's mental health status and substance use history.
5. Indicate any specific needs or accommodations required by the patient.
6. Ensure all required consent forms are signed and included.
7. Review the completed form for accuracy before submission.

Who needs GA PSHP Intensive Outpatient/Day Treatment Form?

1. Individuals seeking intensive outpatient or day treatment for mental health or substance use disorders.
2. Patients transitioning from inpatient treatment who require continued support.
3. Individuals needing structured therapeutic programs to manage their recovery.

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What is GA PSHP Intensive Outpatient/Day Treatment Form?

The GA PSHP Intensive Outpatient/Day Treatment Form is a document used to collect information related to an individual's participation in intensive outpatient or day treatment programs in Georgia.

Who is required to file GA PSHP Intensive Outpatient/Day Treatment Form?

Providers of intensive outpatient or day treatment services in Georgia are required to file the GA PSHP Intensive Outpatient/Day Treatment Form on behalf of eligible patients.

How to fill out GA PSHP Intensive Outpatient/Day Treatment Form?

To fill out the GA PSHP Intensive Outpatient/Day Treatment Form, providers must input relevant patient information, treatment details, and any required codes or identifiers as specified by the guidelines.

What is the purpose of GA PSHP Intensive Outpatient/Day Treatment Form?

The purpose of the GA PSHP Intensive Outpatient/Day Treatment Form is to ensure proper documentation and reporting of services provided, facilitating reimbursement and quality monitoring.

What information must be reported on GA PSHP Intensive Outpatient/Day Treatment Form?

The information that must be reported includes patient demographics, treatment dates, types of services provided, clinician details, and any relevant insurance information.