Get Wv Targeted Case Management Form 2015-2025

Filling out the WV Targeted Case Management Form accurately is essential for ensuring proper support and services for individuals in need. This guide will provide you with a detailed, step-by-step process to complete the form online, making it accessible and efficient.

Follow the steps to complete the form online effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the 'Student name' in the designated field at the top of the form. It is important to ensure the name matches the one listed on the Service Plan.
3. In the 'Service Plan Date' field, input the date that corresponds with the service plan to ensure it is properly documented.
4. Fill in the 'Medicaid Number,' 'Last Name,' 'WVEIS Number,' 'Date of Birth,' and 'County' fields accurately. This information is vital for verification and processing.
5. Identify the 'Targeted Case Manager' by printing their name in the provided space. This ensures accountability and identification.
6. Input the 'Diagnosis Code' and 'Month/Year Service Provided' to clearly outline the context of the services rendered.
7. Select the 'School' and include the 'Procedure Code' related to the services performed. For targeted case management, use code T1017 SE.
8. Record the 'Date of Service' when services were provided, ensuring it aligns with the documented service plan.
9. Under the 'Progress Note' section, describe the 'Type of Contact' (Face to Face, Correspondence, or Telephone Contact), 'Activity', 'Purpose', and 'TCM Activity'. This gives a clear account of interactions.
10. For continuous logging, include 'Time In' and 'Time Out' to account for the duration of service, noting the 'Total Minutes' accordingly.
11. The 'Signature & Credentials' field must be completed by the case manager for verification purposes. Add the date to document when the note was made.
12. Repeat the relevant steps for any additional service sessions documented on the form to maintain a comprehensive record.
13. Once all fields are completed, save changes, download, print, or share the form as needed to ensure proper submission.

Start completing your WV Targeted Case Management Form online today!