Get Casii Template

This guide provides clear and professional instructions on how to complete the Casii Template online. By following these steps, users can efficiently fill out the necessary information while ensuring accuracy and compliance.

Follow the steps to complete the Casii Template online.

1. Click the ‘Get Form’ button to access the Casii Template and launch it in your preferred editor.
2. In Box 1, enter the client's last name in UPPER CASE BLOCK LETTERS, ensuring clarity in letters such as U, V, I, L, D, and O.
3. In Box 2, input the client's first name similarly in UPPER CASE BLOCK LETTERS with attention to the same letters.
4. In Box 3, provide the middle initial of the client in UPPER CASE BLOCK LETTERS with appropriate clarity.
5. In Box 4, enter the client’s date of birth using the format mm-dd-yyyy, ensuring leading zeros are included where necessary.
6. In Box 5, indicate the child's gender by entering 'F' for female or 'M' for male.
7. In Box 6, input the Medicaid Recipient Identification Number for the client as the Prime Number; this is mandatory for capitated members.
8. In Box 7, enter the completed referral date for determination, using the mm-dd-yyyy format and including leading zeros as appropriate.
9. In Box 8, select the appropriate referral source code from the provided list and enter it.
10. In Box 9, fill in the date of determination following the same date format.
11. In Box 10, input the appropriate CMHP Identifier if applicable.
12. Proceed to Boxes 12-19, where you will enter numerical scores for each domain, ranging from 1 to 5, as indicated in the instructions.
13. In Box 20, calculate and enter the Composite CASII Score based on the provided formula.
14. In Box 21, indicate if the child is determined ISA by entering 'Y' for yes or 'N' for no.
15. In Box 22, recommend a level of care by selecting a number from 1 to 6.
16. In Box 23, enter the end date for ISA services following the provided date format.
17. In Box 24, enter the provider case number if applicable.
18. In Box 25, include any additional comments or references as needed.
19. Once all fields are complete, you can save changes, download, print, or share the completed form.

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