Get Ga Pshp Allwell Discharge Consultation Form

Completing the GA PSHP Allwell Discharge Consultation Form online is a straightforward process designed to capture essential information for effective discharge planning. This guide will provide you with detailed, step-by-step instructions to ensure you fill out the form accurately and efficiently.

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 member's name in the designated field, ensuring correct spelling. Proceed to include their phone number and date of birth accurately.
3. Fill out the parent or guardian's name if applicable, and input the member's identification number and address in the relevant sections.
4. Indicate the best time to reach the member, parent, or guardian, as this information is crucial for follow-up communications.
5. Complete the facility name section and provide the name of the utilization manager (UM). Don’t forget to include the facility's fax number.
6. Provide details for emergency contacts and list the outpatient therapist and psychiatrist along with their contact numbers.
7. Fill in the date of the next appointment and the case manager's details if applicable. Also, note their phone number for continuity of care.
8. Mark whether the member has sufficient medication to last until their follow-up, selecting 'Yes' or 'No' based on the circumstance.
9. List any additional follow-up appointments, including the name/type of provider, the provider's phone number, and the date of the next appointment.
10. If applicable, indicate if the member attended a 513 appointment during the discharge process, providing the staff's name, phone number, and details of the appointment.
11. Fill in the name and phone number of the medical provider or primary care physician (PCP), making sure to provide accurate contact information.
12. Enter the current ICD diagnoses, including primary, secondary, and any tertiary or additional diagnoses as relevant.
13. Document the medications that the member will have at discharge.
14. Describe the discharge disposition, noting where the member will be staying after discharge.
15. Finally, ensure all signatures from facility staff are included along with the admission and discharge dates.
16. Review the completed form for accuracy, then save your changes. You may download, print, or share the form as necessary.

Complete your GA PSHP Allwell Discharge Consultation Form online today for a seamless discharge process.