Pm form 2026

1. Click ‘Get Form’ to open the pm form in the editor.
2. Begin by entering the 'Date and Time of CON' at the top of the form. Ensure you select the correct date and time for accurate record-keeping.
3. In the 'Type of Service Requested' section, check the appropriate box for either 'Psychiatric Acute Hospital', 'Residential Treatment Center', or 'Sub-acute Facility'.
4. Fill in the 'Client Information' fields, including Name, Address, AHCCCS ID, Date of Birth, Social Security Number, and Provider Phone Number. Double-check for accuracy.
5. Complete the DSM-IV Diagnostic Codes by filling in Axis I through Axis V as applicable to provide a comprehensive overview of the client's condition.
6. Provide detailed responses to the questions regarding treatment necessity and expected outcomes. This information is crucial for justifying inpatient care.
7. Have the physician sign and print their name in the designated area, along with dating it appropriately.
8. Finally, indicate the proposed placement details and requested service dates before submitting your completed form.

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