Get Crisis Plan Short(fillable Form Version) - Tn.gov - Tn

This guide provides a detailed overview of how to complete the Crisis Plan Short(fillable Form Version) available online. By following these instructions, users can effectively document crucial information for crisis prevention and intervention.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in your chosen editing tool.
2. In the demographics section, enter the individual's name, region, date, ID number, date of birth, telephone number, and address. Select the appropriate living situation by checking the corresponding box.
3. For medical information, fill in the Axis I through Axis V sections with the individual's diagnosis, Medicaid number, Medicare number, insurance details, and any other relevant medical information.
4. List any current medications, including both prescription and over-the-counter drugs, along with their dosages and frequency of intake. Make sure to enter the date of the current medication list.
5. In the medical/dental conditions section, provide information regarding any relevant conditions that should be noted.
6. State the preferred communication style of the individual, indicating their primary language and any other necessary communication preferences.
7. Outline the strengths, skills, and interests of the individual. This may help caregivers and providers to understand the individual's unique abilities.
8. Complete the circle of support/providers section by noting relevant names, agencies, addresses, and telephone numbers for each support person involved.
9. In Part II, describe general behavior patterns and factors that may increase stress for the individual. Mention alternatives that have proven effective to prevent a crisis.
10. Part III requires you to specify successful past options for individuals to receive help outside their home, including preferred facilities.
11. In Part IV, outline the back-up protocol detailing specific steps for crisis response, including contact information and procedures to follow.
12. Finally, in Part V, gather signatures from individuals in the circle of support, including optional signatures from the individual and essential providers. Ensure the date is recorded.
13. After completing the form, save any changes, and utilize options to download, print, or share the form.

Start filling out your Crisis Plan Short online today for better preparedness and support.