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Cigna behavioral health questionnaire 2026
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- Click ‘Get Form’ to open the Cigna Behavioral Health Questionnaire in the editor.
- Begin by entering the Claimant Name and Date of Birth at the top of the form. This information is essential for identifying the patient.
- In the Dates of Treatment section, list all relevant treatment dates, including the first and most recent visits, along with the Next Scheduled Office Visit.
- Fill in the DSM IV-TR Diagnosis Code and Description fields. Provide details for each Axis (I-V) as applicable, including Current GAF scores.
- Describe Clinical Signs and Symptoms that impact functionality. Be specific about cognitive impairments or any suicidal/homicidal history.
- Complete the Mental Status Exam section by providing observations on Alertness, Behavior, Orientation, Speech, Thought Process, Judgment, Insight, and Cognitive Impairment.
- Address Substance Abuse History by indicating whether there is a history of substance abuse and provide further details if applicable.
- Continue through sections on Past Psychiatric History, Social Interactions/Demeanor, Activities of Daily Living, Treatment Plan, Return to Work Plan, Referrals, Alternative Work Setting, Ability to Perform Temperaments, and Provider Information. Ensure all fields are filled accurately.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2008 | 4.7 Satisfied (61 Votes) |
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