Psychological Evaluation Form - DSHS 13-865
The Psychological Evaluation Form is essential for assessing mental health conditions and required for reimbursement. It includes comprehensive sections on client information, impairment claims, and clinical findings. This form is crucial for professionals conducting evaluations in Washington State.
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How do I fill this out?
To fill out the Psychological Evaluation Form, ensure you have all necessary client information at hand. Start by completing the client information section accurately, followed by the clinical findings. Finally, make sure to review the form before submission for completeness and accuracy.
How to fill out the Psychological Evaluation Form - DSHS 13-865?
1
Gather all necessary client information.
2
Complete the sections on client impairment and clinical findings.
3
Ensure all documentation is attached according to the instructions.
4
Review the form for accuracy and completeness.
5
Submit the form to the appropriate agency.
Who needs the Psychological Evaluation Form - DSHS 13-865?
1
Mental Health Professionals who conduct evaluations.
2
Social Workers assisting clients with mental health claims.
3
Clients seeking reimbursement for psychological services.
4
Insurance Providers needing evaluation documentation.
5
Legal Representatives involved in cases regarding mental health.
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What are the instructions for submitting this form?
Submit the completed Psychological Evaluation Form via fax to (XXX-XXX-XXXX) or email as a PDF attachment to clientsupport@dshs.wa.gov. Ensure that all necessary documentation is attached before submission. For mail submissions, send the form to: Department of Social and Health Services, Mental Health Division, P.O. Box 12345, City, State, ZIP.
What are the important dates for this form in 2024 and 2025?
The current version of the Psychological Evaluation Form is applicable until further notice, with no specific updates expected for 2024 and 2025. Regularly check for any updates to the form and associated guidelines to ensure compliance. It’s recommended to stay informed through the DSHS website for any procedural changes.
What is the purpose of this form?
The purpose of the Psychological Evaluation Form is to provide a systematic approach for evaluating clients' mental health conditions. This form enables health professionals to document their findings comprehensively, ensuring that all necessary information for reimbursement and clinical assessment is captured. It serves as a critical resource for both the practitioner and the client in navigating healthcare services.
Tell me about this form and its components and fields line-by-line.
- 1. Client Information: Details about the client such as name, date of birth, and ID.
- 2. Authorization to Release Information: Consent for sharing personal health information.
- 3. Clinical Interview: Questions regarding psychosocial history, medical and work history.
- 4. Clinical Findings: Summary of findings and symptoms affecting the individual's ability to work.
- 5. Assessment / Diagnosis: Listing of all applicable diagnoses related to the client's condition.
What happens if I fail to submit this form?
Failing to submit the Psychological Evaluation Form can result in delays in reimbursement and processing of benefits. Additionally, missing information may hinder the evaluation process, which can affect the client's access to necessary services. Ensure timely submission to avoid disruptions in care and processing.
- Delayed Reimbursement: Without submission, claims for services may be held up.
- Access to Services: Clients may not receive timely access to necessary mental health services.
- Incomplete Evaluations: Important clinical information might not be available for ongoing care.
How do I know when to use this form?
- 1. Initial Evaluations: Use during the first assessment of a new client.
- 2. Updating Client Information: When there is a significant change in the client's condition.
- 3. Reimbursement Processing: Required for claims submitted to the DSHS.
Frequently Asked Questions
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Simply type in the required information in each section. Be sure to review your entries for accuracy.
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Refer to the guidelines provided in the form for detailed information on each section.
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Yes, a signature is required for the form to be valid.
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