Get Mental Health Crisis Hold Tracking Form

This guide provides clear instructions on how to effectively complete the Mental Health Crisis Hold Tracking Form online. It aims to assist users in accurately filling out each section to ensure proper documentation and support for mental health care.

Follow the steps to successfully complete the form

1. Press the ‘Get Form’ button to access the Mental Health Crisis Hold Tracking Form and open it in your preferred online editor.
2. Begin by entering the name and medical record number (MRN) at the top of the form. This information uniquely identifies the individual for whom the form is being completed.
3. Provide the facility name along with the corresponding identification number. Specify the name of the program associated with this individual and enter its ID.
4. Fill in the provider's name and their identification number. It is crucial to include accurate details to ensure proper contact and accountability.
5. Record the elapsed time in total minutes spent on the service. This section helps in tracking the duration of treatment provided.
6. Enter the service start date by selecting the appropriate date format. Ensure that this aligns with the treatment timeline.
7. In the ‘Code Activity’ section, check the appropriate location for service delivery — whether it was conducted in an office, field, school, or via telehealth.
8. In the discharge diagnosis section, fill in the ICD-10 code and write the primary DSM-5 diagnosis followed by the narrative that describes the diagnosis.
9. If applicable, provide secondary ICD-10 codes and corresponding DSM-5 diagnoses along with their narratives.
10. Outline the course of treatment, including opening and closing dates, referral source for admission, discharge medications, allergies, and treatment outcomes.
11. Detail the discharge plans, making recommendations and noting possible future problems and referrals outlined for ongoing care.
12. At the end of the form, provide the signature, license, designation, and printed name of the provider. If a co-signature is required, include that information as well.
13. Once all sections are completed, review the form for accuracy. You can then save changes, download, print, or share the form as needed.

Complete your Mental Health Crisis Hold Tracking Form online today to ensure proper documentation and support.