Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Enter the client's name in the designated field at the top of the form.
3. Fill in the month and year of services provided in the specified section.
4. List the primary diagnosis under Axis I and Axis II as applicable.
5. Provide the Client Report (CR) number and indicate the eligibility status.
6. If applicable, include any secondary diagnoses under Axis I and Axis II.
7. Enter the client’s date of birth and the level of care for this treatment.
8. Indicate any tertiary diagnosis under Axis I.
9. Circle all applicable service formats utilized this month, such as individual, group, or family sessions.
10. Select the service settings used, including options like home, school, or community.
11. Enter the service dates for the period under review.
12. Identify and number the targets addressed this month, choosing from the provided list of options.
13. Check the progress ratings for each of the targets endorsed, selecting the appropriate rating.
14. List all intervention strategies used during the month by checking the relevant boxes.
15. Document any psychiatric medications administered, including total daily doses and schedules.
16. If applicable, note the projected discharge date and any changes during this month.
17. Specify the discharge living situation and reasons for discharge if the youth was discharged.
18. Optionally, report any outcome measures, attaching recent scores if available.
19. Add any comments or suggestions as necessary, attaching additional sheets if required.
20. Fill in the provider agency, clinician name, and ID, and ensure both clinician and supervisor signatures are obtained.
21. Submit the completed form to CAMHD by the due date.

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