Form Details

• Form Properties
  1. Form Title: NYSCRI Initial Psychiatric Evaluation
  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 - Yes
• Lookup Tables - No
• Pre-Fill Logic
  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.
  3. Diagnoses on Axis Tab will prefill from diagnosis listed in ICD 10 Diagnosis Table (Administration ICD 10/DSM 5) or most recent signed and locked Diagnosis form/tab.
• Fill to Logic
  1. Diagnosis tab will fill any new Diagnosis or Assessment forms and the read-only Diagnosis tab in Patient Details.
  2. Needs identified will fill the Goal/Needs section of a Treatment Plan.
• Signatures
  1. Individual Signature
     • Sig type: Patient
  2. Guardian Signature
     • Sig type: Any
  3. Physician/NPP Signature
     • Credential required to sign: Physician, NP, MD.
     • Title will fill title entered in user setup.
     • Signature required.
     • Route To functionality is available.
  4. Supervisor Signature
     • Credential required to sign: Supervisor.
     • Title will fill from title entered in user setup.
     • Defaults to N/A checked.
     • Route To functionality is available.

Patient Info Tab

• The Organization Name will prefill from the Program/Billing Defaults/Company information.
• The Program Name will prefill from the Program the client is enrolled in.
• To enter a description of the problem for a child or adolescent, check the box to enable the text box.
• If no History of Present Illness to report, check the box for None Reported.
• If a Comprehensive Assessment has been completed, click the Yes radio button to open the date field.

See Program/Billing Defaults, Programs.

History Tab

All fields required.

Mental Status Tab

• Selecting the Refer to Attached Mental Status Evaluation will grey out the narrative text box and Danger to section.
• Selecting Denied any Danger to Self/Others will grey out the Self and Others options.

Axis Tab

• You must select a Primary diagnosis.

• ICD 10 Diagnosis Code - Will pull from diagnosis listed in ICD 10 Diagnosis table (Administration ICD10/DSM5) or most recent previously completed diagnosis form/tab.
• Specifier - Set up Specifier Lookup table (Specifiers – ICD10) in Lookup Manager (see Lookup Manager).

Medications Tab

• Selecting the Yes radio button indicating medical conditions exist requiring consideration will open the text field to provide specifics.
• Selecting N/A for Individual's/Guardian's Response will grey out the text box.

Evaluation Tab

• The Issues for Children/Adolescent section will grey out automatically if the patient is under the age of 18.

Needs Tab

• Selecting None in the Individual Declined/Deferred/Referred Out-Provide Rationale(s) section will grey out the 3 fields.

Signatures Tab

1. Signature Type Credentials
   • Individual Signature
     • Sig type: Patient
   • Guardian Signature
     • Sig type: Any
   • Physician/NPP Signature
     • Credential required to sign: Physician, NP, MD.
     • Title will fill title entered in user setup .
     • Signature required.
     • Route To functionality is available.
   • Supervisor Signature
     • Credential required to sign: Supervisor.
     • Title will fill from title entered in user setup .
     • Defaults to N/A checked.
     • Route To functionality is available.

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