Get Cigna Behavioral Health Questionnaire

Completing the Cigna Behavioral Health Questionnaire is a crucial step in managing mental health support. This guide provides clear instructions to help you fill out the form accurately and efficiently, ensuring that you convey all necessary information effectively.

Follow the steps to complete the questionnaire with ease.

1. Press the ‘Get Form’ button to access the Cigna Behavioral Health Questionnaire and open it in your preferred editing tool.
2. Begin by filling out the claimant's name and date of birth in the designated fields to identify the patient.
3. List the dates of treatment, including the first and most recent sessions, along with the next scheduled office visit.
4. Provide the DSM IV-TR diagnosis code and description, filling out information for Axis I through Axis V and noting the current GAF score.
5. Detail the clinical signs and symptoms that impact the person's functionality, intensity, and duration as per the DSM IV-TR criteria related to the diagnosis.
6. Complete the mental status exam section by entering relevant observations regarding alertness, behavior, orientation, and other mental health indicators.
7. Indicate whether there is a substance abuse history and provide descriptions as needed.
8. In the past psychiatric history section, specify if previous treatments exist and give details if applicable.
9. Describe the patient’s current social interactions and demeanor, including the frequency and types of interactions with friends and family.
10. In the activities of daily living section, describe the patient’s ability to perform personal care and related tasks, highlighting any specific activities they struggle with.
11. List current medications, dosages, and any relevant treatment information under the treatment/treatment plan section.
12. Detail the return to work plan, indicating the date the patient may return to work and whether they can do so full time, part time, or with any restrictions.
13. Specify whether referrals to other providers have been made, and if so, include their names and contact information.
14. Explain the patient’s ability to perform job duties in an alternative work setting, if necessary.
15. Indicate the patient’s ability to perform various temperaments and summarize any cognitive strengths or limitations related to their work ability.
16. Fill out the provider information including name, telephone number, address, fax number, signature, credentials, and specialty.
17. Once all sections are complete, save your changes, and download or print the form for submission.

Complete your questionnaire online to ensure timely processing and support.