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Form Details

• Form Properties
  1. Form Title: NYSCRI Adult Comprehensive Assessment Update
  2. Start from an Existing Form Yes, NYSCRI Adult Comprehensive Assessment v2.
  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 Yes, Diagnosis
• 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 is enrolled in.
  3. Date of most recent Comprehensive Assessment will prefill from NYSCRI Adult Comprehensive Assessment v2 completion date.
  4. Diagnosis Tab will prefill from any form with Diagnosis.
• Fill to Logic Yes
  1. Diagnosis Tab will fill to any form with a Diagnosis.
  2. Identified needs will fill to the NYSCRI Initial Individualized Action Plan / NYSCRI Individualized Action Plan Review.
• Signatures
  1. Individual Served Signature
     • Credential: Patient
     • Manually type in name.
  2. Guardian Signature
     • Credential: None
     • Manually type in name.
  3. Provider Signature
     • Credential required to sign: Provider.
     • Title will fill title entered in user setup.
     • Route To functionality is available.
  4. Clinical Supervisor Signature
     • Credential required to sign: Clinical Supervisor.
     • Title will fill title entered in user setup.
     • Defaults to NA checked.
     • Signature required if NA is unchecked.
     • Route To functionality is available.
  5. Team Leader Signature
     • Credential required to sign: Team Leader.
     • Title will fill title entered in user setup.
     • Defaults to NA checked.
     • Signature required if NA is unchecked.
     • Route To functionality is available.
  6. Psychiatrist Signature
     • Credential required to sign: Psychiatrist.
     • Title will fill title entered in user setup.
     • Defaults to NA checked.
     • Signature required if NA is unchecked.
     • Route To functionality is available.

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Update Tab

1. Organization Name and Program Name will prefill from Program/Billing Defaults.
2. Select a reason for the update.
3. Date of most recent Comprehensive Assessment will prefill from NYSCRI Adult Comprehensive Assessment v2 last completion date.
4. Check the box(es) next to the section(s) of the assessment (including addendums), which you are updating.
5. List each assessment section being updated with narrative explanation below it.
6. Select if any evidence-based screening tool(s), for either mental health or substance use, was utilized. If yes, specify.
   • Grey out- Selecting No will grey out the text field.

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Diagnosis Tab

1. Select if there is/is not a change to the diagnosis.
2. Enter any changes to Diagnosis (if necessary).

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Needs Tab

1. Enter any service preferences.
2. Enter any additional treatment recommendation/assessed needs (if necessary).
   • Grey out- Selecting no additional recommendations clinically indicated will grey out the Needs table.
3. Explain why individual declined to work on needs area and/or indicate rationale(s) for why need area(s) is deferred/referred out.

NOTE: Treatment Recommendation/Assessed Needs and Individual Declined/Deferred/Referred Rationale(s) section populates from previous version.

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Treatment Tab

1. Select any further evaluations needed (if any).
   • Grey out- Selecting None Indicated will grey out options.
2. Enter any level of care/indicated service recommendations.
   • Grey out- Selecting No change will grey out text field.
3. Enter any individual served/guardian/family responses to recommendations.
4. Select if a change in IAP is required.
   • If yes, completed the IAP Revision/Review form to record needed changes in goal(s), objective(s), interventions, services, frequency, and/or provider type.

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Signatures Tab

Signature Credentials (see Credentials)

1. Individual Served Signature
   • Credential: Patient
   • Manually type in name.
2. Guardian Signature
   • Credential: None
   • Manually type in name.
3. Provider Signature
   • Credential required to sign: Provider.
   • Title will fill title entered in user setup.
   • Route To functionality is available.
4. Clinical Supervisor Signature
   • Credential required to sign: Clinical Supervisor.
   • Title will fill title entered in user setup.
   • Defaults to NA checked.
   • Signature required if NA is unchecked.
   • Route To functionality is available.
5. Team Leader Signature
   • Credential required to sign: Team Leader.
   • Title will fill title entered in user setup.
   • Defaults to NA checked.
   • Signature required if NA is unchecked.
   • Route To functionality is available.
6. Psychiatrist Signature
   • Credential required to sign: Psychiatrist.
   • Title will fill title entered in user setup.
   • Defaults to NA checked.
   • Signature required if NA is unchecked.
   • Route To functionality is available.

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