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Get FL Catholic Charities Case Record Peer Review Tool (OMH) 2004-2024

Te case closed (if applicable): District #: Name of Program/Service: Location: Name of provider: ITEM: YES NO COMMENTS of REVIEWER CORRECTIVE ACTION 1. Client s name and/or ID # are documented on exterior of the case record. 2. Intake form complete. 3. Payment record up to date. (If applicable) 4. Client Rights & Responsibilities/Consent for Services and HIPAA forms signed & dated. 5. Appropriate referrals are made when needs cannot be met. 6. Progress note documentation reflects ne.

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