(D)
Documentation requirements.
The assessment must include all elements and tools required by the OHCA. In the
case of members under the age of eighteen (18), it is performed with the
direct, active, face-to-face participation of the member and foster parent(s)
or legal guardian or other persons, including biological parent(s) when
applicable. The member's level of participation is based on age, developmental,
and clinical appropriateness. The assessment must include all related diagnoses
from the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The
assessment must contain, but is not limited to, the following:
(i) Date, to include month, day, and year of
the assessment session(s);
(ii)
Source of information;
(iii)
Member's first name, middle initial, and last name;
(iv) Gender;
(v) Birth date;
(vi) Home address;
(vii) Telephone number;
(viii) Referral source;
(ix) Reason for referral;
(x) Person to be notified in case of
emergency;
(xi) Presenting reason
for seeking services;
(xii) Start
and stop time for each unit billed;
(xiii) Dated signature of foster parent(s) or
legal guardian [Oklahoma Department of Human Services (OKDHS) or Oklahoma
Office of Juvenile Affairs (OJA)] or other persons, including biological
parents(s) (when applicable) participating in the face-to-face assessment.
Signatures are required for members fourteen (14) years of age and over;
(xiv) Bio-psychosocial information
which must include:
(I) Identification of the
member's strengths, needs, abilities, and preferences;
(II) History of the presenting problem;
(III) Previous psychiatric
treatment history, including treatment of psychiatric issues, substance use,
drug and alcohol addiction, and other addictions;
(IV) Health history and current biomedical
conditions and complications;
(V)
Alcohol, drug, and/or other addictions history;
(VI) Trauma, abuse, neglect, violence, and/or
sexual assault history of self and/or others, including OKDHS involvement;
(VII) Family and social history,
including psychiatric, substance use, drug and alcohol addiction, other
addictions, and trauma/abuse/neglect;
(VIII) Educational attainment, difficulties,
and history;
(IX) Cultural and
religious orientation;
(X)
Vocational, occupational, and military history;
(XI) Sexual history, including human
immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), other
sexually transmitted diseases (STDs), and at-risk behaviors;
(XII) Marital or significant other
relationship history;
(XIII)
Recreation and leisure history;
(XIV) Legal or criminal record, including the
identification of key contacts (e.g. attorneys, probation officers);
(XV) Present living arrangements;
(XVI) Economic resources; and
(XVII) Current support system, including peer
and other recovery supports.
(xv) Mental status and level of functioning
information, including, but not limited to, questions regarding the following:
(I) Physical presentation, such as general
appearance, motor activity, attention, and alertness;
(II) Affective process, such as mood, affect,
manner, and attitude;
(III)
Cognitive process, such as intellectual ability, social-adaptive behavior,
thought processes, thought content, and memory; and
(IV) All related diagnoses from the DSM-V.
(xvi) Pharmaceutical
information for both current and past medications, to include the following:
(I) Name of medication;
(II) Strength and dosage of medication;
(III) Length of time on the
medication; and
(IV) Benefit(s)
and side effects of medication.
(xvii) LBHP's interpretation of findings and
diagnosis; and
(xviii) Dated
signature and credentials of the qualified practitioner who performed the
face-to-face behavioral assessment. If performed by a licensure candidate, it
must be countersigned by the LBHP who is responsible for the member's care.