Get State Of Minnesota - Health Professionals Services Program

Filling out the State of Minnesota - Health Professionals Services Program Treatment Provider Report Form online is a straightforward process. This guide will provide you with a step-by-step approach to ensure you complete the form accurately.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to access the Treatment Provider Report Form in the digital format.
2. Begin by selecting the quarter the report covers by circling the appropriate option for 1/15, 4/15, 7/15, or 10/15.
3. In the section for 'Client/Patient Name,' print the full name of the individual receiving treatment.
4. Specify the primary treatment focus in the designated area.
5. Indicate the secondary treatment focus and provide the number of visits in the last quarter.
6. Detail the current symptoms observed in the client/patient, ensuring to provide a thorough description.
7. In the 'Client/Patient Insight' section, provide any relevant insights regarding the client's condition and progress.
8. Document any instances of relapse or symptom exacerbation to provide insight into the client's treatment journey.
9. Outline the treatment plan, recommendations, and any interventions that were implemented.
10. List any medications the client/patient is currently taking in the appropriate section.
11. If there are any work restrictions, be sure to note them clearly.
12. Fill in the agency name, treatment provider name, and agency phone number as required.
13. The treatment provider should sign and date the form to validate it.
14. Once completed, you can save changes, download or print the form as necessary. Ensure all additional sheets or notes are attached before submission.
15. Mail the completed form to HPSP at 1380 Energy Lane, Suite 202, St. Paul, MN 55108 or fax it to (651) 643-2163.

Complete your documents online for a streamlined process.