Get Eap Case Record Form - Search For Mhnet Providers

Filling out the EAP Case Record Form is essential for proper documentation and billing within the EAP process. This guide provides a clear and supportive step-by-step approach to ensure that you complete the form accurately and efficiently.

Follow the steps to properly fill out the EAP Case Record Form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the confidential contact history. Input the client’s name, Social Security Number (SSN), employee name, employee SSN, date of birth, and phone number in the designated fields.
3. Indicate the client’s relationship to the employee by selecting one of the options: Employee, Spouse/Significant Other, or Dependent Child.
4. Fill in the company/division/location along with the provider's name and billing address. Make sure to include the city, state, and ZIP code as well as the Tax ID Number or Employer Identification Number (EIN) and authorization number.
5. In the service history section, record the billed amount and date of service for each service rendered. Enter the hours worked and the relevant type code for the services provided.
6. Assess and document the client's problems, including the DSM IV diagnosis in Axis 1. Indicate the case status, engagement level, symptom resolution, work effect minimization, treatment goal progress, and current Global Assessment of Functioning (GAF).
7. Complete the confidential service plan and statement of understanding towards the end of the assessment. Explain the plan to the client and ensure they sign, alongside the EAP counselor who witnesses the signature.
8. Fill out the client agreement to consent to release information, including any necessary signatures and contact details for the Primary Care Physician (PCP).
9. After completing the form, review it to ensure all sections are completed. You can save the changes, download, print, or share the form as needed for submission.

Complete the EAP Case Record Form online today to ensure timely processing and support.