Initial Comprehensive Treatment Plan (NYIAP)

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Form Details

• Form Properties
  1. Form Title: Initial Comprehensive Treatment Plan
  2. Start from an Existing Form - Yes, if there is a previous version signed and locked.
  3. Copyrighted Form - No
  4. Billable Progress Note - No
  5. Have multiple versions open at same time - No
  6. Open Blank on new version - No
• Required Fields - None
• Lookup Tables - None
• Pre-Fill Logic - Yes
  1. Organization Name will prefill from Setup → Program/Billing Defaults → Company Info Tab.
  2. Program Name will prefill from the Program the patient enrolled in.
• Fill to Logic - None
• Signatures
  1. Individual Served Signature (Optional)
     • Sig type: Patient
  2. Parent/Guardian Signature (Optional)
     • Sig type: None
     • Name needs to be entered.
  3. Staff Signature
     • Sig type: Any
     • Route-To available.
     • Signature locks the form.
  4. Supervisor / QHP Signature
     • Sig type: Supervisor / QHP
     • N/A box defaults to unchecked.
     • Route-To available.
     • Signature locks the form.
  5. NPP/QHP Other than CASAC Signature
     • Sig type: NPP, QHP, Other than CASAC, NP-non CASAC
     • N/A box defaults to unchecked.
     • Route-To available.
     • Signature locks the form.
  6. Psychiatrist/Medical Staff Signature
     • Sig type: Physician, Psychiatrist, DO, MD
     • N/A box defaults to unchecked.
     • Route-To available.
     • Signature locks the form.
  7. Staff Signatures (4)
     • Sig type: Any
     • N/A box defaults to checked.
     • Route-To available.
     • Signature locks the form.

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Goals Tab

1. Prefill - Organization Name will prefill from Program/Billing Defaults (see eCR University - Program Billing Defaults).
2. Prefill - Program Name will prefill from program individual is enrolled in.
3.  Date Plan Initiated will auto sync to date plan is locked.
4. Next Review Date will auto set when locked based on treatment plan duration requirements set in Program/Billing defaults (see Program/Billing Defaults).
5. Assign Goal number.
6. Assign start and target completion date for the Goal.
7. Need: Drop-down populated with active needs identified in the Comprehensive Assessment or Comprehensive Assessment Update. Select need Goal is based on.
8. Define goal details.
9. Select Add/Updated to populate Goal information to the Goal grid.
10. Goal grid: Goals developed will display in the Goal grid.
11. Clear: Clears text fields (does not remove information from the grid).

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Objectives Tab

1. Goal: Goals from Goal tab will populate in the Goal grid box.
   • Select the goal objective is to be associated to.
2. Goal# will prefill based on goal selected in the grid.
3. Objective: text field, assign Objective letter.
4. Objective Description: text field, enter objective statement.
5. Start Date / Target completion Date: Date picker, enter start/target date for objective.
6. Adjusted target date: Enter adjust target date (not typically used on the first plan).
7. Objective details: Text fields
8. Add/Update: Select when object completed. Selecting will add the objective to the Objective grid.
9. New: Will clear all objective text and date fields to enter another objective associated to the goal.
10. Clear: Will clear all objective text and date fields with exception of Objective letter, objective statement and Start/Target Date to enter another objective detail associated with the Objective letter/Objective Statement.
11. Remove: Will remove the objective from the grid.
12. Objective grid.

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Goals (Read Only) Tab

1. No input. Goals/objective created above will be listed here.

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Patient Info Tab

1. Transition/Discharge Criteria & Discharge Plan: text fields
2. Individual has participated
   • Grey out - Selecting No will open text field.
3. Others participated
   • Grey out - Selecting Yes will open text field.

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Signatures Tab

1. Signature Credentials (see Credentials)
   • Individual Served Signature (Optional)
     • Sig type: Patient
   • Parent/Guardian Signature (Optional)
     • Sig type: None
     • Name needs to be entered.
   • Staff Signature
     • Sig type: Any
     • Route-To available.
     • Signature locks the form.
   • Supervisor / QHP Signature
     • Sig type: Supervisor / QHP
     • N/A box defaults to unchecked.
     • Route-To available.
     • Signature locks the form.
   • NPP/QHP Other than CASAC Signature
     • Sig type: NPP, QHP, Other than CASAC, NP-non CASAC
     • N/A box defaults to unchecked.
     • Route-To available.
     • Signature locks the form.
   • Psychiatrist/Medical Staff Signature
     • Sig type: Physician, Psychiatrist, DO, MD
     • N/A box defaults to unchecked.
     • Route-To available.
     • Signature locks the form.

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Additional Signatures Tab

1. Signature Credentials (see Credentials)
   • Staff Signatures (4)
     • Sig type: Any
     • N/A box defaults to checked.
     • Route-To available.
     • Signature locks the form.

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