Cigna behavioral health questionnaire 2026

1. Click ‘Get Form’ to open the Cigna Behavioral Health Questionnaire in the editor.
2. Begin by entering the Claimant Name and Date of Birth at the top of the form. This information is essential for identifying the patient.
3. 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.
4. Fill in the DSM IV-TR Diagnosis Code and Description fields. Provide details for each Axis (I-V) as applicable, including Current GAF scores.
5. Describe Clinical Signs and Symptoms that impact functionality. Be specific about cognitive impairments or any suicidal/homicidal history.
6. Complete the Mental Status Exam section by providing observations on Alertness, Behavior, Orientation, Speech, Thought Process, Judgment, Insight, and Cognitive Impairment.
7. Address Substance Abuse History by indicating whether there is a history of substance abuse and provide further details if applicable.
8. 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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