NYSCRI Adult Comprehensive Assessment v2 (NYACA2)

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Form Details

• Form Properties
  1. Form Title: NYSCRI Adult Comprehensive Assessment v2
  2. Start from an Existing Form - Yes, if there is a previous assessment 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 - Yes
• 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. Active Medications on Psychiatric Tab will prefill from ePrescribing.
  4. Diagnosis Tab will prefill from any form with Diagnosis.
• Fill to Logic - Yes
  1. NYSCRI Adult Comprehensive Assessment v2 Form will fill to NYSCRI Adult Comprehensive Assessment Update Form.
  2. Diagnosis Tab will fill to any form with a Diagnosis.
  3. 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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Presenting Concerns Tab

1. Organization Name and Program Name will prefill from Program/Billing Defaults.
2. Enter a reason for referral.
3. Select the individual’s current living situation.
4. Select if the individual is in a residential care/treatment facility.
5. Select if the individual is at risk of losing their current housing. If yes, add comments.
6. Select if the individual is satisfied with their current living situation. If yes, add comments.

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Family Tab

1. Comment on persons living with individual, other than their children.
2. Enter any family information.

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Development Tab

1. Enter any developmental history, developmental disabilities, and/or sexual history/concerns.
2. Enter any social supports for the individual.

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Legal (LIA, LSA) Tab

1. Religion/Spirituality - enter if applicable.
2. Legal Status
   • Does individual served have a legal guardian, if response is Yes, the Legal Status Addendum will open.
   • Form will not lock if Yes is selected and the Legal Status Addendum is not completed.
3. Legal Involvement History
   • Does the individual have a history of..., if response is Yes, the Legal Involvement Addendum will open.
   • Form will not lock if Yes is selected and the Legal Involvement Addendum is not completed.

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Education Tab

1. Check and enter any education history that applies.
2. Select and enter the employment status.
3. Enter any employment history.

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Military (EA, MSA, MSO, SUA) Tab

1. Select fields based on employment status.
   • If responding yes to ‘Does the individual want help to find employment and/or further their educational training the Employment/Education Assessment will open.
     • Form will not lock if addendum is not completed.
2. Select fields based on military service.
   • If responding Yes to ‘Have you ever served in the military’, the Military Service Assessment will open.
     • Form will not lock if addendum is not completed.
   • If responding Yes to ‘Is someone in your family in the military, the Military Significant Other Assessment will open.
     • Form will not lock if addendum is not completed.
3. Select fields based on substance use/addictive behavior history.
   • If any current use reported, the Substance Use Addendum will open.
     • Form will not lock if addendum is not completed.

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TX History Tab

1. Enter any treatment services within the past five years.
2. Enter details for outpatient services.
3. Enter details for inpatient services.
4. Enter details for ER/detox services.
5. Enter additional information and/or comments about the past treatment.

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Psychiatric Tab

1. Describe any psychiatric illness history.
2. Enter any reported medication side-effects, medication compliance and/or comments on past medication.
   • Selecting ‘Patient has no active medications’ will grey out the medication grid.
3. Select any experiences of trauma history.
   • Grey out - selecting ‘None Reported’ will grey out options.

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Past Risk (RA) Tab

1. Select if there were any past attempts by the individual to harm themselves or others.
   • Selecting Self or Other to ‘Past attempts to harm self or others’ will open the Risk Assessment
     • Form will not lock if Addendum is not completed.
2. Select and describe any past alerts that may contribute to the patient being a risk to themselves or others.

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Mental Status (MSE, RA) Tab

1. Select and describe any violent events that resulted in injury, involved a weapon and/or involved. the individual being influenced by drugs or alcohol at the time.
2. Enter a mental health evaluation narrative or complete the Mental Status Evaluation.
   • Selecting ‘Refer to attached Mental Health Evaluation’ will open the Mental Status Evaluation.
   • If entering a mental health narrative, complete risk related questions.
     • If any risks selected, Risk Assessment will open.
       • Form will not lock if Addendum is not completed.

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Assessed Needs Tab

1. Select any applicable options regarding challenges, problems in daily living, barriers, obstacles that are assessed needs and add comments or check the box to complete a functional assessment.

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Addictive Behaviors Tab

1. Select any applicable options regarding addictive behaviors and add comments.
2. Select any applicable options regarding behavior management and add comments.

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Social Support Tab

1. Select any applicable options regarding family and social support and add comments.

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Mental Tab

1. Select any applicable options regarding mental health and illness management and add comments.

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Physical Tab

1. Select any applicable options regarding physical health and add comments.
2. Select any applicable options regarding risk/safety and add comments.

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Other Tab

1. Select any applicable options regarding legal problems and any other area or need not mentioned and add comments.
2. Select if any evidenced-based screening tool(s), for either mental health or substance use, utilized and specify if yes.
3. Enter any life goals, strengths, abilities, and barriers.

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Clinical Tab

1. Enter any barriers to care and existing gaps.
2. Enter any past and present successes in achieving desired goals.
3. Describe any service preferences.
4. Complete the Clinical Summary by checking and entering information and enter the Interpretive Summary.

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Diagnosis Tab

1. Add/edit the diagnosis - required field.

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Eval Tab

1. Select any further evaluations needed.
2. Assessed needs will populate in the table.
3. Enter a priority for the assessed needs.

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Rationale Tab

1. Explain why individual declined to work on needs are and/or list rationale(s) for why need area(s) is deferred/referred out below.
2. Enter a level of care/indicated service recommendations.
3. Enter the individual served/guardian/family response to recommendations.
4. Individual Served Signature
   • Credential: Patient
   • Manually enter name in name field when signing name.
5. Guardian Signature
   • Credential: None
   • Manually enter name in name field when signing name.

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Signatures Tab

Signature Credentials (see Credentials)

1. Provider Signature
   • Credential required to sign: Provider.
   • Title will fill title entered in user setup.
   • Route To functionality is available.
2. 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.
3. 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.
4. 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.
5. Displays if addendums are required/completed.
   • If an assessment addendum was triggered to be completed it will indicate in the Addendum summary.
     
     

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