MENTAL HEALTH DISCHARGE SUMMARYBILLING FORM - cchealth 2025

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The document is a Mental Health Discharge Summary/Billing Form that outlines the discharge diagnosis, course of treatment, discharge medications, allergies, treatment outcomes, discharge plans, recommendations, potential future problems, and referrals for a client. It includes sections for staff details, location of services provided, and requires signatures from licensed professionals.

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Click ‘Get Form’ to open the MENTAL HEALTH DISCHARGE SUMMARY BILLING FORM in the editor.
Begin by entering the CLIENT NAME and MRN at the top of the form. This information is crucial for identifying the patient.
Fill in the DATE and RU# fields to document when the discharge summary is being completed.
Select the CODE ACTIVITY that corresponds to the services provided, ensuring you check only one option.
In the DISCHARGE DIAGNOSIS section, provide a clear diagnosis that reflects the patient's condition upon discharge.
Detail the COURSE OF TREATMENT, including opening and closing dates, referral sources, discharge medications, allergies, and treatment outcomes.
Outline DISCHARGE PLANS by listing recommendations, possible future problems, and any referrals out that may be necessary for continued care.
Finally, ensure all signatures are completed at the bottom of the form along with their respective license titles before saving or sharing your document.

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