Get Worksheet For Requesting Exceptions To The Diversion Law (sb 859) - Ncdhhs

Completing the Worksheet for Requesting Exceptions to The Diversion Law (SB 859) is an important process for ensuring that individuals with mental health needs receive appropriate care. This guide provides clear, step-by-step instructions to assist you in filling out the form accurately and effectively online.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to retrieve the worksheet and open it for editing.
2. Begin by entering the consumer's name, date of birth, and the date on which the form is completed. Ensure the information is accurate and clear.
3. Next, provide details about the Local Management Entity (LME) where the client resides during the crisis, including the phone number.
4. Indicate the name and title of the person completing the form. This should reflect the individual filling out the worksheet.
5. Enter the name of the examining physician and the date of the examination, ensuring these details are up-to-date.
6. Fill in the guardian's name and contact number, if applicable, to provide relevant contact information.
7. List all diagnoses of the consumer to give a comprehensive view of their condition.
8. Proceed to the exception criteria section based on your findings. If the consumer meets criteria 1 or 2, stop filling out the form, as they do not require further approval.
9. If you are addressing Exception 3, carefully evaluate the dangerousness criteria by checking the relevant boxes and providing a detailed explanation of the consumer's behavior and conditions.
10. For Exception 4A, assess the medical fragility criteria and clearly describe how the consumer’s medical and psychiatric conditions justify this exception.
11. For Exception 4B, confirm the consumer's cultural deafness and provide information about their communication needs and circumstances.
12. Document all non-State hospitals contacted regarding admission and detail the reasons for any denials to ensure proper record-keeping.
13. Include NC START involvement, if applicable, and detail the date, contact person, and disposition of the referral to provide a complete overview.
14. At the end of the form, the authorized LME employee must sign, indicating approval for the exception, and include the date and time.
15. Once all sections are complete, you can save the changes, download, print, or share the form as needed.

Complete your exceptions worksheet online today to ensure timely support and care for those in need.