Get Psych Eval

Completing the Psych Eval form online can streamline the process of psychological evaluation. This guide will walk you through each section of the form step by step, ensuring you provide all necessary information accurately.

Follow the steps to fill out the Psych Eval form successfully.

1. Press the ‘Get Form’ button to access the Psych Eval form and open it in your document editor.
2. Begin by entering the patient’s name and date of birth in the designated fields. Make sure this information is accurate as it is crucial for identification.
3. Proceed to fill in the employee’s or subscriber’s name, along with the employer or insurance plan details. Include the employee's Social Security Number to facilitate processing.
4. Specify the patient’s relationship to the employee or subscriber to clarify the context of the evaluation.
5. In the next section, enter the name of the psychologist conducting the evaluation, including their degree, state license, and license number.
6. Indicate whether the psychologist is part of a network or a non-network provider. Answer the question regarding independent licensing with 'Yes' or 'No' as applicable.
7. Fill in the psychologist's complete contact information, including address, telephone number, city, state, and ZIP code, along with their Tax Identification Number.
8. In section C, answer who initiated the referral and provide the MD’s specialty if appropriate. Describe current symptoms and their duration in detail.
9. Clearly outline the referral questions and the reasoning for requesting testing at this time.
10. Specify any possible DSM-IV-TR diagnoses under evaluation, including the relevant axes and ICD 9 codes if applicable.
11. Provide a comprehensive history of the patient, summarizing psychosocial and medical information, including examination dates and past treatments.
12. Explain how the proposed testing will enhance treatment and influence future psychological strategies.
13. Address any other psychological explanations for current behaviors or symptoms by answering the yes/no question and providing an explanation if necessary.
14. List the planned tests along with the estimated time required for each, ensuring you include administration, scoring, and interpretation.
15. Finally, sign and date the form at the bottom to confirm the information is accurate and complete.
16. Once all fields are filled, you may save changes, download, print, or share the completed form as needed.

Start completing your Psych Eval form online today for a smooth evaluation process!