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Mental Health Crisis Hold Tracking Form

Mental Health Crisis Hold Tracking Form 2026

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4.6 out of 5

51 votes

The document is a Mental Health Discharge Summary and Billing Form that includes patient identification details, treatment information, discharge diagnoses with ICD-10 and DSM-5 codes, course of treatment, discharge plans, and recommendations for future care. It serves as a comprehensive record of the patient's mental health treatment and billing information.

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Click ‘Get Form’ to open the Mental Health Crisis Hold Tracking Form in the editor.
Begin by entering the patient's NAME and MRN at the top of the form. This information is crucial for identification.
Fill in the Facility Name, Program Name, and Provider details along with their respective IDs to ensure accurate record-keeping.
Document the Elapsed Time (Total Minutes) and Service (Begin) Date to track service duration effectively.
Select the appropriate Code Activity and Location from the provided options, ensuring that you accurately reflect where services were rendered.
In Section 1, provide detailed discharge diagnoses including ICD-10 Codes and DSM-5 Diagnoses for both primary and secondary conditions.
Outline the Course of Treatment by filling in opening and closing dates, referral sources, discharge medications, allergies, and treatment outcomes.
Complete the Discharge Plans section with recommendations, possible future problems, and referrals out as necessary.
Finally, ensure all signatures are completed along with printed names and dates for verification purposes.

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See more Mental Health Crisis Hold Tracking Form versions

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Versions	Form popularity	Fillable & printable
2023	4.7 Satisfied (54 Votes)
2022	4.6 Satisfied (51 Votes)
2013	4.8 Satisfied (297 Votes)

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Got questions?

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 to do if an employee is having a mental health crisis?

Lead with empathy and compassion and remind your colleague of the resources they have access to, such as NAMIs HelpLine (1-800-950-NAMI), your Employee Assistance Program, covered physical and mental health services, and more.

How do physical and mental health programs address this crisis and what additional approaches could be considered?

Physical and mental health programs address the crisis by promoting well-being and resilience. Additional approaches could include mindfulness training and peer support groups. Self-esteem is crucial for healthy relationships as it fosters confidence and mutual respect.

What is the 3 month rule in mental health?

Behaviour change is key, this may be the more typical signs such as: Seeming sad Lacking energy. Loss of interest in day-to-day life. Withdrawn. Negative thoughts. Anxious. Low self-esteem.

How do I track my mental health?

Let your bujo become a mood journal and reflect your moods over time. Jot down your mood patterns throughout the day. This will help you find the triggers for your bad moods. Daylio is one such simple tool that helps to record your habits, and activities and generate daily reminders.

How to track your mental health?

Select your symptoms or moods. Based on your mental health condition, well suggest symptoms or moods that may be helpful to track. Log them on a simple scale. Youll rate how each symptom impacts your daily functioning. Add notes or journal entries. See how your symptoms change. Make the most of your next appointment.