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Arkansas Division of Medical Services (DMS) Early Intervention Day Treatment (EDT) INITIAL EVALUATION REFERRAL (DSM642 ER) The primary care provider (PCP) or substitute physician must use this form
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How to fill out for a patient to
How to fill out for a patient to
01
Obtain the patient's medical history information including past illnesses, surgeries, and current medications.
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Record the patient's vital signs such as temperature, blood pressure, heart rate, and respiratory rate.
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04
Perform a physical examination to assess the patient's overall health condition.
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Fill out any necessary forms or paperwork with the patient's information and findings from the visit.
Who needs for a patient to?
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Any healthcare professional such as a doctor, nurse, or medical assistant who is providing care for the patient.
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What is for a patient to?
A patient's needs, medical history, and information on their health condition.
Who is required to file for a patient to?
Healthcare providers, doctors, and hospitals are required to file for a patient.
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To fill out for a patient, you need to provide accurate and detailed information about the patient's health and medical history.
What is the purpose of for a patient to?
The purpose is to ensure that the patient receives appropriate and timely medical care.
What information must be reported on for a patient to?
Information such as the patient's name, age, medical history, current health condition, and any prescribed medications.
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