Phase 2 Psychopharmacology Plan Review (NYPSPPR)

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Form Details

• Form Properties
  1. Form Title: Phase 2 Psychopharmacology Plan
  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 – 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. Identified needs will prefill from the most recent completed Assessment.
• Fill to Logic – None
• Signatures
  1. Individual Served Signature
     • Sig type: Patient
  2. Parent/Guardian Signature
     • Sig type: None
  3. NPP Signature
     • Sig type: NPP
     • N/A defaults to unchecked.
     • Route to function available.
     • Signature locks form.
  4. Psychiatrist/MD/DO Signature
     • Sig type: Physician, Psychiatrist, DO, MD
     • N/A defaults to unchecked.
     • Route to function available.
     • Signature locks form.
  5. Staff Signatures (2)
     • Sig type: Any
     • N/A defaults to unchecked.
     • Route to function.
     • Signature locks form.

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Patient Info Tab

1. Indicate Organization, Program, and Plan initiation and target completion dates (all required).
2. Information will prefill from Phase 2 Psychopharmacology Plan.
   • Modify Goal & Objective information as desired.

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Goal 2 Tab

Information will prefill from Phase 2 Psychopharmacology Plan.

• Modify Goal & Objective information as desired.

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Goal 3 Tab

Information will prefill from Phase 2 Psychopharmacology Plan.

• Modify Goal & Objective information as desired.

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Goal 4 Tab

Information will prefill from Phase 2 Psychopharmacology Plan.

• Modify Goal & Objective information as desired.

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Transition/Discharge Criteria Tab

1. Indicate any changes to Transition / Discharge Criteria.
2. Indicate if Individual or Others have participated in program development (required).
3. Signature Certifications
   • Individual Served Signature
     • Sig type: Patient
   • Parent/Guardian Signature
     • Sig type: None

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Signatures Tab

1. Signature Credentials (see eCR University - Credentials)
   • NPP Signature
     • Sig type: Physician, PA, NP, MD
     • N/A defaults to unchecked.
     • Route to function.
     • Signature locks form.
   • Psychiatrist/MD/DO Signature
     • Sig type: Physician, Psychiatrist, DO, MD
     • N/A defaults to unchecked.
     • Route to function.
     • Signature locks form.
   • Staff Signature
     • Sig type: Any
     • N/A defaults to checked.
     • Route to function.
     • Signature locks form.

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Signatures (cont) Tab

1. Staff Signatures (3) (see eCR University - Credentials)

• Sig type: Any
• N/A defaults to checked.
• Route to function.
• Signature locks form.

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