Prior Authorization / Adult Mental Health Day Treatment Attachment (Pa/amhdta) Page 3
Download a blank fillable Prior Authorization / Adult Mental Health Day Treatment Attachment (Pa/amhdta) in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Prior Authorization / Adult Mental Health Day Treatment Attachment (Pa/amhdta) with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4PRIOR AUTHORIZATION / ADULT MENTAL HEALTH DAY TREATMENT ATTACHMENT (PA/AMHDTA)
Page 3 of 4
F-11038 (07/12)
SECTION III — DOCUMENTATION (Continued)
15. Specify overall character of service to be provided.
Rehabilitation
Maintenance
Stabilization
16. Identify measurable treatment goals.
17. Attach a specific schedule of activities, including date, time of day, length of session, and service to be provided.
18. Estimate the member’s rehabilitation potential for employment (competitive, supported, sheltered, etc.), social interaction, and
independent living.
Continued
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business