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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the participant's name and SSN in the designated fields at the top of the form. This information is crucial for identification purposes.
- Fill in the Healthy Connections Physician, Medicaid number, and Healthy Connection number. Ensure accuracy as these details are essential for processing.
- Complete the diagnostic summary section by checking applicable boxes for emotional disturbances or mental illnesses. This helps in understanding the participant's needs.
- For each functional area identified, specify issues, goals, objectives, and tasks. Make sure objectives are concrete and measurable with clear time frames for completion.
- Finally, gather signatures from all participants involved in developing the treatment plan. This confirms agreement and consent for information exchange.
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