Request for Psychiatric Evaluation (SC_RPE)

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Form Details

• Form Properties
  1. Form Title: Request for Psychiatric Evaluation
  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 – Yes
• Lookup Tables – None
• Pre-Fill Logic – Yes
  1. Requested By will prefill with the user that is logged in
  2. Approved By/Denied By will prefill with the user that approved/denied the request
• Fill to Logic – None
• Signatures
  1. Signature
     • Sig Type: Any
     • Signature locks the form

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Referral Request Tab

1. Indicate reason for referral request – Required
2. Describe presenting problem – Required
3. State specific referral question – Required

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Routing Tab

1. Indicate approval, denial, or re-routing of the request – Required
2. Signature Credentials (see Credentials - Create, Assign & Edit)
   • Signature
   • Sig Type: Any
   • Signature locks the form
3. Selecting Schedule will launch the scheduler (see Scheduler - Scheduler Setup)

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Routing History Tab

1. Routing history will display. No input in this section
2. Add comments to individual routing record

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