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

1. Click ‘Get Form’ to open the PSHP - Intensive Outpatient Day Treatment Form in the editor.
2. Begin by filling out the 'Member Information' section. Clearly print the member's name, date of birth, and member ID number.
3. 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.
4. 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.
5. Proceed to describe the 'Current Presentation/Symptoms'. Detail the member's situation and symptoms affecting their functioning across various domains.
6. Fill in the 'MH/SA Treatment History' and 'Current Psychotropic Medications' sections accurately, noting any previous treatments and medications prescribed.
7. Complete the 'Treatment Goals' section by outlining measurable goals agreed upon with the member, ensuring clarity on progress made.
8. Finally, review all entries for completeness before submitting via mail or fax to ensure timely processing.

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