Get Program Utilization Form -

Filling out the Program Utilization Form online is a straightforward process that ensures necessary information is accurately submitted for service utilization. This guide provides step-by-step instructions to help you navigate the form with ease and confidence.

Follow the steps to successfully complete the form online.

1. Click the 'Get Form' button to obtain the form and open it in your online editor.
2. Begin by entering the therapist's name in the designated field. This is crucial for identifying the professional responsible for the services provided.
3. Input the ACI authorization number (ACI Auth#) in the corresponding section. This number is essential for processing your request.
4. If applicable, provide the facility name where the services were rendered.
5. Enter your email address to ensure you receive any necessary follow-up communications regarding your submission.
6. Record the date of referral in the space provided, ensuring the format is MM/DD/YYYY for consistency.
7. In the employee data section, fill in the company name of the employee who is covered by the Employee Assistance Program (EAP).
8. Next, enter the employee's name to link them directly to the services reported.
9. In the client data section, indicate the client's name, which may also be the employee if they are receiving services.
10. Input the date seen, using the MM/DD/YYYY format, to document when the session occurred.
11. Select the session type by marking an ‘X’ in the appropriate box for either No Show, Face-to-Face, or Telephonic sessions.
12. Choose the case disposition by selecting either Open or Closed to accurately reflect the status of the case.
13. If the status is Closed, provide the date closed in the same MM/DD/YYYY format.
14. Once all information has been accurately filled out, you can choose to print or submit the form via the available options.

Complete your Program Utilization Form online today to streamline the service utilization process.