NYSCRI Risk Assessment Form (NYRAF)

Form Details

• Form Properties
  1. Form Title: NYSCRI Risk Assessment Form
  2. Start from an Existing Form - No
  3. Copyrighted Form - No
  4. Billable Progress Note - No
  5. Have multiple versions open at same time - No
  6. Open Blank on new version - Yes
• 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. Signature
     • Sig type: Physician, PA, NP, MD
  2. Supervisor Signature
     • Sig type: QHP, Clinical Staff, Nurse, Therapist, Case Manager, Physician, Patient, PA, NP, MD, Clinic Director.
     • NA box defaults to checked when form is opened.
     • Route-to function is available.
     • Signature locks the form.

Suicide Tab

1. Prefill - Organization Name will prefill from Program/Billing Defaults (see Program / Billing Defaults).
2. Prefill - Program Name will prefill from the program client is enrolled in.
3. Suicide Assessment - Check if no suicidal thoughts have ever occurred. If checked suicide assessment will grey out.
4. Current/Today
   • Grey out - If selecting No for Attempt or Treated medically, associated text fields will grey out.
5. Last 30 Days - two columns are provided if more than one occasion in the in the 30 days.
   • Grey out
     • 1st column/2nd column, if selecting No for Attempt or Treated medically, associated text fields will grey out.
     • 2nd column, if selecting No for Ideation, entire column will grey out.
6. Past Year - two columns are provided if more than one occasion in the in the past year.
   • Grey out
   • 1st column/2nd column, if selecting No for Attempt or Treated medically, associated text fields will grey out.
   • 2nd column, if selecting No for Ideation, entire column will grey out.
7. Prior Dates
   1. Grey out - If selecting No for Ideation, Attempt or Treated medically, associated text fields will grey out.

Homicide Tab

1. Homicide Assessment - Check if no suicidal thoughts have ever occurred. If checked homicide assessment will grey out.
2. Current/Today
   • Grey out - If selecting No on Towards individual, Plan or Attempt, associated text fields will grey out.
3. Last 30 Days - two columns are provided if more than one occasion in the in the 30 days.
   • Grey out
     • 1st column/2nd column, If selecting No on Ideation, Towards individual, Plan or Attempt, associated text fields will grey out.
     • 2nd column, if selecting No for Ideation, entire column will grey out.
4. Past Year - two columns are provided if more than one occasion in the in the past year.
   • Grey out
     • 1st column/2nd column, If selecting No on Ideation, Towards individual, Plan or Attempt, associated text fields will grey out.
     • 2nd column, if selecting No for Ideation, entire column will grey out.
5. Prior Dates
   • Grey out - If selecting No on Ideation, Towards Individual, Plan or Attempt, associated text fields will grey out.
6. Comment / Plan of Action - open text field.

Signatures Tab

Signature Credentials (see Credentials)

1. Signature
   • Sig type: Physician, PA, NP, MD
2. Supervisor Signature
   • Sig type: QHP, Clinical Staff, Nurse, Therapist, Case Manager, Physician, Patient, PA, NP, MD, Clinic Director.
   • N/A box defaults to checked when form is opened.
   • Route-to function is available.
   • Signature locks the form.

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