Get Crisis Intervention/stabilization Form - Alaska Department Of Health ... - Dhss Alaska

This guide provides clear and supportive instructions on how to effectively fill out the Crisis Intervention/Stabilization Form provided by the Alaska Department of Health. Designed for users of all experience levels, it ensures that you can complete the form accurately and efficiently online.

Follow the steps to complete the form online:

1. Press the ‘Get Form’ button to access the form and open it in the appropriate editor.
2. Fill in the 'Contact Date' to record when the crisis intervention took place.
3. Enter the patient's name in the designated field to identify the individual receiving services.
4. Provide the patient's address to ensure proper record-keeping and service delivery.
5. Indicate the 'Start Time' of the intervention as well as the 'Stop Time' to document the duration of the service.
6. Input the case or record number for internal tracking purposes.
7. Record the patient's date of birth (DOB) for identification.
8. Fill in the Medicaid ID and Insurance ID if applicable, to assist with billing and insurance processes.
9. Specify the duration of the intervention in the corresponding field.
10. Choose the 'Location' from the options provided, such as 'By Appointment' or 'In Home', and specify in the 'Other' field if necessary.
11. Detail the symptoms related to the complaint by selecting the appropriate boxes or specifying additional symptoms in the 'Other' section.
12. List psychosocial or environmental features affecting the patient, marking applicable options and detailing any 'Other' circumstances.
13. Assess the 'Presenting Risk' level based on the current situation by selecting from the provided risk categories.
14. Describe the 'Presenting Problem' to clarify the nature of the crisis being addressed.
15. For the 'Assessment' section, summarize the recipient's mental, emotional, and behavioral status in relation to the crisis, including any recommendations.
16. In the 'Treatment Plan', outline the recommended services and interventions that will be provided.
17. Provide details about the services rendered and interventions carried out by the clinician or behavioral health clinic associate.
18. In the 'Follow-Up Disposition', describe the outcome of the intervention, such as referrals or hospitalizations.
19. Enter the clinician's name and credentials, signing where indicated.
20. If applicable, the behavioral health clinic associate should also provide their signature and credentials.
21. Finally, review all fields for accuracy, then save changes, download, print, or share the completed form as needed.

Start filling out your Crisis Intervention/Stabilization Form online today to ensure timely support.