Get Clinical Summary Template

The Clinical Summary Template is an essential document utilized by the Children’s System of Care to determine appropriate service levels for youth. Completing this template accurately is crucial for effective support and treatment planning.

Follow the steps to fill out the Clinical Summary Template with ease.

1. Click ‘Get Form’ button to obtain the Clinical Summary Template and open it in your chosen online editor.
2. Fill in the date at the top of the form. Ensure all entries are typed clearly and accurately.
3. Provide your name, credentials, agency information, and contact details in the designated assessor fields.
4. Enter the youth's personal information, including their name, gender, date of birth, race/ethnicity, and CYBER ID#.
5. Document the parent or legal guardian's details, including name, guardianship status, contact information, and address.
6. Indicate the primary language spoken at home and the reason for submitting the Clinical Summary Template.
7. Outline the current status and treatment involvement of the youth, noting any relevant behavioral health and physical health issues.
8. Identify risk behaviors and presenting symptoms by checking applicable boxes and providing additional details as necessary.
9. List the youth's strengths and any relevant life domain functioning needs by checking the appropriate boxes.
10. Fill in information regarding caregiver strengths and needs, including relationship to the youth.
11. Provide a history of treatment and youth system involvement over the past three years across all relevant categories.
12. Include current DSM-5 behavioral health diagnoses and all relevant details of the youth’s clinical summary and treatment plan.
13. Document all information sources, including their relationship to the youth and contact information.
14. Once completed, review the form for accuracy, then transmit it by fax to 1-877-736-9166.

Complete the Clinical Summary Template online today to ensure timely and effective support for youth!