SERIOUS MENTAL AND EMOTIONAL TRAUMA (SMET) VERIFICATION FORM 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Claim Number, Patient/Victim Name, SSN, Address, and Date of Birth in the designated fields.
3. Indicate the Date of Crime and answer whether the client suffered serious mental or emotional trauma by selecting 'Yes' or 'No'.
4. If you answered 'Yes', provide a detailed description of the nature of the trauma in the space provided.
5. Fill in the Date Treatment Began and specify the type of treatment being provided by checking appropriate boxes and listing names if necessary.
6. Answer questions regarding prescribed medications post-crime and any prior medications, providing details as required.
7. Document diagnosis using DSM codes and categories, ensuring accuracy for effective processing.
8. Assess and check the severity of dysfunction on a scale from 1 to 9.
9. Describe present symptoms and areas of dysfunction comprehensively to aid in understanding client needs.
10. Detail any psychological tests administered along with their relevance to treatment needs.
11. Conclude with a brief description of your treatment methods including frequency and projected duration before signing off with your credentials.

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