Get Tricare Otr Form

Filling out the Tricare Outpatient Treatment Report form online is a straightforward process that ensures your treatment details are properly documented. This guide provides clear, step-by-step instructions to assist you in completing each section of the form accurately.

Follow the steps to fill out your Tricare Otr Form with ease

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Fill in the identifying data section by entering the patient’s name, date of birth, and sponsor number. Ensure all information is complete to prevent any delays.
3. Complete the provider information section. Input the provider's name, phone number, and fax number as required.
4. Document the DSM-IV TR diagnosis by filling in the relevant Axis I, Axis II, and Axis III codes along with the dates of first and last seen, and the anticipated number of sessions for treatment.
5. In the treatment report section, circle the relevant current clinical information for aggression, impulsivity, alcohol/substance use, and other listed conditions, indicating their severity on a scale of 0 to 4.
6. Define the discharge goals by selecting one of the options: complete remission, significant improvement, or baseline/maintenance.
7. If applicable, provide information about medications, keeping in mind this section is optional for non-physicians.
8. Select the type of treatment provided from the options listed. Choose all methods that are applicable to the treatment.
9. Specify requested services by filling in the CPT codes and their frequencies for each service needed.
10. Finally, ensure the provider's signature and date are included to validate the form. Review all entered information for accuracy.
11. Once you have filled out all sections, you can save your changes, download the form, print it for physical submission, or share it as required.

Complete your document online today to streamline your care process.