Universal Charge Data Invoice (CDI) Mental Health Program Outpatient Services - sbcounty 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Clinic Name' and 'Reporting Unit' as per your records. Ensure these details are accurate for proper tracking.
3. Fill in the 'Service Date' corresponding to when the service was provided, followed by the 'Primary Staff Number' and 'Client Number'.
4. Input the 'Client Name' exactly as it appears in medical records, ensuring consistency for billing purposes.
5. Enter the appropriate 'Procedure Code' for the service rendered, referring to your chart notes for accuracy.
6. Indicate the 'Group Count', which is essential if services were provided in a group setting.
7. Document both 'Primary Staff Time' and 'Co-Staff Time', detailing time spent on services and related tasks as accurately as possible.
8. Select the correct 'Service Location' code from the provided list, ensuring it matches your interdisciplinary notes.
9. If applicable, mark any relevant indicators such as Pregnancy or Emergency status with a ‘Y’.
10. Finally, ensure all entries are certified by signing where indicated and noting who completed data entry along with the date.

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