NYSCRI Screening Admission Note (NYSAN)

Form Details

• Form Properties
  1. Form Title: NYSCRI Screening Admission Note
  2. Start from an Existing Form - No
  3. Copyrighted Form - No
  4. Billable Progress Note - Yes
  5. Have multiple versions open at same time - No
  6. Open Blank on new version - Yes
• Required Fields - Yes
• Lookup Tables - Yes
  1. Code will pull from Facilities.
  2. Service Code will pull from Visit Types.
• 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.
  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 - Yes
  1. Diagnosis tab will fill any new Diagnosis or Assessment forms and the read-only Diagnosis tab in Patient Details.
• Signatures
  1. Individual Signature (Optional)
     • Sig type: Patient
  2. Staff Signature
     • Sig type: Any
     • Route-To is available.
     • Signature locks the form.
  3. Supervisor Signature
     • Sig type: Supervisor
     • N/A box defaults to unchecked.
     • Route-To is available.
     • Signature locks the form.

Information Tab

1. Note Date of Service.
2. Note Start Time.
3. Select appropriate Service Code.
4. Indicate if Individual is over/under 18 years old.
   • Grey out - No will grey out text field.

Axis Tab

1. Diagnosis
   • Prefill - Diagnosis will prefill from previously completed diagnosis form or diagnosis tab in another form.

Info Tab (1 of 2)

1. Provide Narrative of screening information.
2. Indicate Admission/Non-admission.
3. Provide narrative support for decision.
4. Describe Individual’s strengths.

Info Tab (2 of 2)

1. Describe Needs.
2. Indicate Initial Services to be provided.
3. Indicate collaterals for select programs.

Signatures Tab

1. Signature Credentials (see Credentials)
   • Individual Signature (Optional)
     • Sig type: Patient
   • Staff Signature
     • Sig type: Any
     • Route-To is available.
     • Signature locks the form.
   • Supervisor Signature
     • Sig type: Supervisor
     • N/A box defaults to unchecked.
     • Route-To is available.
     • Signature locks the form.

History Tab

1. No input. Individual’s Screening Admission note history is displayed.

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