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Locus worksheet pdf 2021-2026

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  1. Click ‘Get Form’ to open the locus worksheet PDF 2021 in the editor.
  2. Begin by entering the 'Date of Assessment' at the top of the form, ensuring it reflects the date you completed the assessment.
  3. Fill in the 'Recipient Date of Birth' using the format MM/DD/YYYY, and select 'Male' or 'Female' for 'Recipient Gender'.
  4. Provide either the Recipient PMI or Social Security Number, with a preference for PMI.
  5. In the 'Diagnosis' section, write in the full name of the primary diagnosis or include its ICD code.
  6. For each dimension evaluated (Risk of Harm, Functional Status, etc.), check the appropriate rating and document any criteria used for scoring on the line provided.
  7. Calculate and enter your 'Composite Score' by summing up scores from all dimensions.
  8. Complete fields for Provider Name, NPI, Service Type, and specify both 'Level of Care Recommendation' and 'Actual Level of Care Provided'.
  9. Document any services referred to in the designated section.
  10. Finally, sign and date where indicated. If applicable, have a clinical supervisor sign as well.

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The LOCUS is based on a set of parameters that an individual is scored along. The level of care is determined based on the mix of parameters that each client has. These parameters are: Risk of Harm. Functional Status.
The LOCUS is an assessment tool that helps clinicians, insurers, and those in need of behavioral health services, to make treatment decisions in a way that is consistent, fair, and effective. The tool provides a common language and way of understanding what care is needed, when and for how long.
Reviews of revised LOCUS assessments should not be more often than every three days for acute intensive care settings such as inpatient psychiatric hospitals, and no more than every month for long term secure care services such state hospitals or community based locked facilities.

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