Get United States Coast Guard Case Activity Form - Valueoptions

Filling out the United States Coast Guard Case Activity Form - ValueOptions online is a straightforward process that ensures your information is submitted accurately for prompt payment. This guide will take you through each section of the form step-by-step, making it easy for you to complete.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to access the form and open it in your editing tool.
2. Begin by filling out the billing type section, selecting whether it is an interim, final, or re-open statement of understanding. Be sure to check the appropriate box.
3. Provide participant information by entering the last name, first name, middle initial, address, state, city, ZIP code, date of birth, and home phone number.
4. Select the participant's ethnicity and gender by checking the appropriate boxes provided.
5. Enter the authorization number and, if applicable, the service member's name, including their last name, first name, and middle initial.
6. In the billing information section, list the dates of service by entering the respective dates in the spaces provided.
7. Fill in the EAP counselor details, including their last name, first name, billing address, and phone number. Additionally, provide their SSN or tax ID number and NPI number.
8. Complete the total sessions billed and the number of EAP sessions used at case closing, along with the counselor’s signature and the date.
9. Choose one presenting problem (P) and one assessed problem (A) by marking the appropriate boxes.
10. Indicate the participant's risk and functional assessment levels at both case opening and closing by checking the corresponding severity levels.
11. If applicable, indicate if this is a high-risk case and if it was reviewed with a ValueOptions consultant, providing their name if necessary.
12. List counseling goals and check the status of whether they were met, partially met, not met, or showed no change.
13. Assess and document EAP/psychiatric history, substance abuse treatment history, strengths and skills, and support systems, noting details as needed.
14. At case closing, indicate the case disposition by checking the appropriate scenario, and note the type of referrals made if any.
15. Once all sections are completed, save the form, and select your option to download, print, or share the completed document as needed.

Complete your United States Coast Guard Case Activity Form - ValueOptions online today to ensure timely processing of your case.