One: Contact Person/Title: Name and Title of Person Authorizing the event: Name and Title of Person Re-authorizing the event: Reporting Information: Recipient Name: SS#: Age: Gender: Male Female CIS Identifier: Diagnoses: Medications: Recipient Behavioral Health Category: SMI Non-SMI SED Non-SED TXIX/XXI Eligible: Y N Date/Time of Evaluation/Assessment: Seclusion: Date Administered: Name/Title: Time: Duration of Seclusion: minutes/hours Mechanical Restraint: Date Administered: Na.
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How to fill out the AZ PM 7.3.1 online
The AZ PM 7.3.1 form is essential for reporting seclusion and restraint incidents in Level I programs. This guide will help you navigate the online form efficiently, ensuring all necessary details are accurately recorded.
Follow the steps to fill out the AZ PM 7.3.1 form online.
- Click the ‘Get Form’ button to access the AZ PM 7.3.1 form and open it in the digital editor.
- Begin by filling in the program or facility information, including the program/facility license number and the name of the program or facility.
- Enter the report date, AHCCCS provider ID, address, and phone number.
- Input the contact person's name and title. Include the names and titles of the persons authorizing and re-authorizing the event.
- In the reporting information section, fill in the recipient's name, social security number, age, and gender. Be sure to indicate the recipient's diagnoses and medications.
- Specify the recipient's behavioral health category (e.g., SMI, Non-SMI, SED, Non-SED). Indicate if the recipient is TXIX/XXI eligible.
- Provide the date and time of evaluation/assessment, then move on to the seclusion section. Enter the details of seclusion, including date administered, name/title of the person administering, time, and duration.
- Complete the mechanical restraint section similarly, providing all relevant details.
- If personal restraint was utilized, fill out that section as well, including similar information.
- Document any drugs or medications used as a restraint, along with dosage and administration details.
- In the next section, describe the de-escalation methods and less restrictive measures attempted prior to seclusion or restraint.
- Provide a rationale for the restraint or seclusion with relevant facts and behaviors leading to the situation.
- Indicate if the person was physically injured during the restraint or seclusion and provide details if applicable.
- List all staff involved in the seclusion or restraint procedure and document monitoring information.
- Fill in the debriefing section, noting the date, time, participants, and outcomes, including any changes to the Individual Service Plan.
- Once all sections are completed, save your changes, and choose to download, print, or share the form as necessary.
Complete your AZ PM 7.3.1 form online today to ensure accurate reporting and compliance.
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Can I file an Arizona tax extension online?
Yes, you can file for an Arizona tax extension online. This allows you to request additional time to prepare your taxes without penalties. By using platforms like uslegalforms, you can efficiently file your extension while taking advantage of AZ PM 7.3.1 features that support your tax needs.
Can amended returns be filed electronically?
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Can an Arizona amended return be filed electronically?
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