Get Fit For Confinement

Filling out the Fit For Confinement form online is a straightforward process designed to ensure that all necessary information is accurately captured for proper assessment. This guide will walk you through each section and field, providing detailed instructions to help you complete the form effectively.

Follow the steps to accurately complete the Fit For Confinement form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor. This will allow you to start filling out each required section.
2. In the 'Requestor Information' section, fill in the requesting agency's name, the name of the agency representative, and their phone number. Choose the type of confinement assessment you are requesting; either medical or psychiatric.
3. In the 'Patient Information' section, the hospital should provide the patient's name, date of birth, and document any current medical problems in the space provided. Include a detailed list of current medications.
4. Under 'Personal Physician,' enter the name of the personal physician and the last time the patient was seen.
5. In the 'Physical Findings' section, provide the patient's vital signs and note any allergies. Make sure to capture all relevant physical findings regarding the patient's condition.
6. Fill out the 'Examination Summary,' including the necessary documentation like lab results, medications given, reports, and any needed future appointments.
7. Answer the questions regarding the patient's medical and psychiatric fit for confinement by selecting either 'Yes,' 'No,' or 'Not Evaluated' for each category.
8. Indicate whether the patient requires inpatient medical or psychiatric treatment. If applicable, note any outpatient recommendations along with specific details about medications or treatments.
9. If there are any precautions related to suicidal thoughts or violent behavior, detail those in the space provided.
10. Complete the 'Facility/Doctor Information' section by providing the facility name, phone number, the printed name of the physician evaluating the patient, and the date and time of evaluation. Ensure the physician or qualified personnel signs the form.
11. Once all fields are completed, you can save your changes, download, print, or share the form as needed.

Start filling out the Fit For Confinement form online today to ensure all necessary evaluations are conducted properly.