Get Value Options Itr Form

This guide provides a clear and supportive step-by-step process for filling out the Value Options Inpatient Treatment Report (ITR) Form online. It is designed to assist users, regardless of their prior experience, in completing the form accurately and efficiently.

Follow the steps to complete the Value Options Itr Form online.

1. Click the ‘Get Form’ button to access the Value Options ITR Form and open it for editing.
2. Enter the requested start date for authorization in the designated field. This should include the month, day, and year.
3. Select the type of services required by checking the appropriate box, including options like Inpatient Acute or RTC.
4. Indicate if this is a transfer request and specify the type of review by selecting the corresponding options.
5. Fill out the section for the beneficiary’s current location by checking the corresponding box.
6. Complete the demographics section with the beneficiary's full name, date of birth, Medicaid ID number, and telephone number.
7. Provide guardian information, if applicable, and the beneficiary’s address with relevant city and state.
8. List the facility information, including the facility name and Medicaid ID number if relevant.
9. Include attending provider details, such as the provider's name, telephone number, and relevant UR (Utilization Review) information.
10. Fill in the DSM-IV diagnosis fields accurately, and identify if the focus of treatment pertains to a developmental disorder.
11. Assess current risks and fill out the risk level scale by circling the appropriate level for each risk category.
12. Complete the section on current impairments, marking the scale for each impairment category based on the beneficiary's condition.
13. Document any mental health or psychiatric history, including treatment compliance and various treatment types experienced.
14. Answer questions regarding the beneficiary's custody status and any criminal justice involvement in the past year.
15. Upon completion, review all entered information for accuracy. Then, save changes, download, print, or share the completed form as required.

Start completing your Value Options ITR Form online now to ensure timely processing of your authorization.