Get Outpatient Review Form (orf2) (pdf) - Valueoptions

Filling out the Outpatient Review Form (ORF2) is a crucial step in seeking authorization for outpatient services. This guide will provide you with clear, instructional steps to successfully complete the form online.

Follow the steps to complete the Outpatient Review Form (ORF2) online.

1. Click the 'Get Form' button to obtain the Outpatient Review Form (ORF2) and open it in your PDF editor.
2. Begin by filling in the requested start date for the authorization. Enter the date in the format of MM/DD/YYYY.
3. Indicate the type of service requested by checking the appropriate box for either mental health or substance abuse.
4. Provide the patient's information, including their name, date of birth, age, gender, address (city/state), phone number, and insurance ID.
5. Fill out the patient's employer or benefit plan, and provide the provider's name along with their license number.
6. If applicable, enter the name of the program or clinic, the VO provider ID number, and the service address.
7. Answer whether you are independently licensed to provide services in the state where treatment is taking place, checking 'Yes' or 'No'.
8. Complete the diagnosis section by filling in the appropriate codes for Axis I, II, III, IV, and the GAF scores.
9. Select from the treatment history options, indicating whether the patient has received previous treatment in the past 12 months and detailing the type.
10. Assess and document the current risk assessment for the patient’s risk to self and others by circling the appropriate values.
11. Indicate any current impairments by evaluating and selecting the appropriate severity levels for each type of impairment.
12. In the treatment plan section, select the primary reason for continued treatment and the types of services provided, specifying the frequency.
13. Report whether the patient's family or supports are involved in treatment and if a psychiatrist has evaluated the patient.
14. List current psychotropic medications, including dosage, frequency, and adherence status.
15. Finally, ensure the treating provider signs the form and dates it, confirming that all information is accurate.
16. Once all fields are completed, save your changes, download, or print the form for submission.

Complete your Outpatient Review Form (ORF2) online to streamline your authorization process.