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PSHP - Intensive Outpatient Day Treatment Form Intensive Outpatient Day Treatment Form

PSHP - Intensive Outpatient Day Treatment Form Intensive Outpatient Day Treatment Form 2026

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The document is an Intensive Outpatient/Day Treatment Form intended for submission to the Utilization Management Department. It requires detailed member and provider information, current risk assessment, treatment history, and current symptoms. The form also includes sections for treatment goals, requested authorization for services, and clinician signatures. It emphasizes the importance of clear and complete information to avoid processing delays.

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Click ‘Get Form’ to open the PSHP - Intensive Outpatient Day Treatment Form in the editor.
Begin by filling out the 'Member Information' section. Clearly print the member's name, date of birth, and member ID number.
Next, complete the 'Provider Information' section. Indicate the primary provider's name, agency/group name, professional credentials, and contact details including phone and fax numbers.
In the 'Current Risk/Lethality' section, assess and mark any suicidal or homicidal ideation. Provide details on past attempts and current safety plans as necessary.
Proceed to describe the 'Current Presentation/Symptoms'. Detail the member's situation and symptoms affecting their functioning across various domains.
Fill in the 'MH/SA Treatment History' and 'Current Psychotropic Medications' sections accurately, noting any previous treatments and medications prescribed.
Complete the 'Treatment Goals' section by outlining measurable goals agreed upon with the member, ensuring clarity on progress made.
Finally, review all entries for completeness before submitting via mail or fax to ensure timely processing.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the difference between SOP and IOP?

Consider your symptoms If your symptoms are severe or worsening, a PHP may be more appropriate due to its intensive nature. On the other hand, if youre managing your symptoms but need additional support, an IOP might be sufficient.

What is the difference between outpatient treatment and intensive outpatient treatment?

Intensive outpatient treatment is distinguished from outpatient counseling by the amount of time the patient spends in the program --- usually nine or more hours a week of treatment.

What is the abbreviation for intensive outpatient program?

An intensive outpatient program (IOP), also known as an intensive outpatient treatment (IOT) program, is a structured non-residential psychological treatment program which addresses mental health disorders and substance use disorders (SUDs) that do not require detoxification through a combination of group-based

What is the intensive outpatient program in the Army?

Intensive Outpatient Program (IOP) is a structured outpatient mental health program designed to provide comprehensive support to veterans and active-duty military. IOP is helpful for clients in recovery from substance abuse or other mental health disorders such as PTSD, acute stress, and depression.

What is the difference between intensive outpatient treatment and outpatient treatment?

First, intensive outpatient programs require clients to report for treatment 3 to 5 days a week for 4 to 6 hours a day. A standard outpatient program only requires clients to attend treatment 1 to 3 days a week for 1 to 3 hours per session. In both cases, treatment could last for as long as several months.

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Should I do PHP or IOP?

There are three main types of outpatient programs, which include intensive outpatient programs, partial hospitalization programs and substance use programs. Each program is designed to aid your mental health in different ways, with different time expectations and program requirements.