Get Cenpatico Psychological Testing Authorization Request Form ...

Completing the Cenpatico Psychological Testing Authorization Request Form online is essential for initiating the testing process for individuals needing psychological evaluation. This guide provides clear instructions to ensure that all necessary information is filled out accurately and completely.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin by filling out the identifying information section, which includes the patient’s name, patient ID number, provider’s name, date of birth, group name, provider’s phone number, fax number, and referral source. Ensure all fields are completed to prevent delays.
3. Move on to the provisional DSM-IV diagnosis section. The provider must report all diagnoses under consideration, ensuring to fill out the Axis I, II, III, IV, and V accordingly. Answer the questions about danger to self or others and the mental status exam, providing explanations if necessary.
4. Describe the current symptoms prompting the need for testing in the appropriate section. Select all relevant symptoms and include any additional notes to clarify the patient's situation.
5. Answer the question regarding what specific issue the testing aims to resolve that cannot be addressed through diagnostic interviews or reviews of records, explaining how the results will affect treatment.
6. In the history section, indicate whether the patient has significant medical illnesses or a history of developmental issues or head injuries. Also, address any family history of psychiatric disorders or abuse by selecting ‘Yes,’ ‘No,’ or ‘Uncertain’ and adding comments.
7. If ADHD is being considered, answer the ADHD-related questions, including intake presentation consistency and any results from ADHD rating scales.
8. If applicable, provide information about high school performance and collateral information obtained from the school regarding cognitive functioning.
9. Fill out the tests planned section by listing all tests intended to answer the clinical questions.
10. Indicate the number of test units requested and ensure the clinician signs and dates the form.
11. Finally, review all entries for accuracy, save your changes, download, print, or share the completed form as required.

Take the next step and complete the Cenpatico Psychological Testing Authorization Request Form online today.