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ODESSA/HCA BEHAVIORAL HEALTH CUSTOMER DATA Curtis form is for adults (18+) only. SECTION Agency:Date of Transaction (MMDDYYYY):Member ID:Date of Birth (MMDDYYYY):RACE: (1Yes for all that apply; Blank
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First, gather all the necessary information of the behavioral health customer such as their personal details, medical history, and any relevant documents.
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The ODMHSASOHCAs behavioral health customer refers to individuals who receive mental health and substance abuse treatment services provided by the Oklahoma Department of Mental Health and Substance Abuse Services and the Oklahoma Health Care Authority.
Providers of mental health and substance abuse services that receive funding or reimbursement through the ODMHSAS and OHCA are required to file the behavioral health customer information.
To fill out the ODMHSASOHCAs behavioral health customer, providers must complete a customer information form that includes personal and demographic details, service information, and treatment history, ensuring all sections are accurately filled.
The purpose of the ODMHSASOHCAs behavioral health customer reporting is to collect data for assessing the effectiveness of services, ensuring compliance with regulations, and improving health outcomes for individuals receiving behavioral health treatment.
Information that must be reported includes the customer's personal demographics, service type, diagnosis, treatment plan, and outcome measures.
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