Get Military Onesource Case Activity Form - Valueoptions

Filling out the Military OneSource Case Activity Form - ValueOptions online is a straightforward process that requires attention to detail. This guide will provide step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the Military OneSource Case Activity Form - ValueOptions and open it in your preferred editor.
2. Begin by selecting the appropriate billing type: Interim, Final, or Re-Open. Tick the corresponding box to indicate your choice.
3. Confirm if a statement of understanding has been signed, and mark ‘Yes’ or ‘No’.
4. Indicate whether the military identification card has been viewed and verified by the provider by selecting ‘Yes’ or ‘No’.
5. Fill in the participant information, including the last name, first name, address, city, state, ZIP code, middle initial, date of birth, and home phone number.
6. Select the participant's ethnicity from the options provided, ensuring to check the correct box.
7. Indicate the participant's gender by selecting either ‘Female’ or ‘Male’.
8. If the service member is not the participant, provide their last name, first name, and middle initial.
9. Enter the dates of service as applicable, using the mm/dd/yy format for each service date.
10. Include the authorization number in the designated field.
11. Select the type of counseling provided: Individual, Couple, or Family.
12. Complete the MOS counselor’s details, including last name, first name, billing address, state, ZIP code, city, SSN or tax ID number, and phone number.
13. Fill in the total number of sessions billed and the NPI number of the counselor.
14. Have the counselor sign and date the form.
15. Indicate the presenting and assessed problems by marking the relevant codes for each issue identified.
16. Respond to the diagnosis questions by selecting ‘Yes’ or ‘No’ and include any necessary details.
17. Conduct a risk and functional assessment, indicating the participant’s level of impairment at both case opening and case closing.
18. Outline the counseling goals and indicate whether they were met, partially met, not met, or if there was no change.
19. Complete any mental health and substance abuse treatment history assessments as required.
20. Provide case summary notes for each date of service and select the case disposition.
21. Select referral types as applicable and finalize by reviewing all entries for accuracy.
22. Once completed, save changes to the form, and if required, download, print, or share the completed document accordingly.

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