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Members Full Name:Medicaid #:SERVICE AUTHORIZATION FORM CHRS & Behavioral Therapy Services CONTINUED STAY Service Authorization Request Remember INFORMATION Member First Name: Member Last Name: Medicaid
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The provided link is for the form CMHRS/BEH/RAPY Continued Stay Assessment.
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The form must be filled out with accurate and updated information regarding the patient's continued stay assessment.
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The form requires information on the patient's progress, current symptoms, medications, treatment plan, and recommendations for continued care.
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