Get Itr Form (pdf) - Value Options

Filling out the Inpatient Treatment Report (ITR) Form online is an essential step in ensuring proper authorization for mental health and substance abuse treatment. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the ITR Form online.

1. Select the ‘Get Form’ button to access the ITR Form and open it in a suitable document editor.
2. Begin with entering the requested start date for authorization at the top of the form, ensuring the date is entered in the format of month/day/year.
3. Indicate the level of care required by selecting one of the options provided, including inpatient, residential, or outpatient services.
4. Choose the type of review that applies to your situation, such as prospective or concurrent, by marking the relevant box.
5. Fill in the patient's current location by selecting from the given options, such as hospital or home.
6. Assess and record any current impairments by using the scale provided (0 for none to 3 for severe) for each listed condition, such as mood disturbances or anxiety.
7. Provide the patient’s demographics, including their name, date of birth, and any relevant identification numbers, ensuring accurate information for processing.
8. Complete the treatment history section, checking applicable options and indicating outcomes of past treatments.
9. Evaluate current risks by circling the appropriate risk level and checking boxes that apply to the patient’s situation.
10. Complete the discharge plan information, including expected discharge dates and planned level of care, ensuring all details are filled out as accurately as possible.
11. Once all sections are filled out, remember to save your changes, and use the options available to download, print, or share the completed form online.

Complete the ITR Form online today for a streamlined authorization process.