PRIOR AUTHORIZATION INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT COMPLETION INSTRUCTIONS, - dhs wisconsin 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section I — Member Information. Enter the member’s name, date of birth, and identification number accurately using the Enrollment Verification System (EVS) for reference.
3. Proceed to Section II — Initial Prior Authorization Request. Fill in the date of initial assessment, presenting problem, diagnoses, symptoms, and a strength-based assessment that reflects both current and historical data.
4. In Section IV — In-Home Recovery/Treatment Plan, outline treatment goals and objectives. Document how the member's strengths will be utilized and provide rationale for in-home treatment.
5. Complete Section VI — Signatures by entering the required signatures from both the certified psychotherapist/substance abuse counselor and the member/legal guardian along with their respective dates.

Utilize our platform today to streamline your form completion process for free!