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Preface to the Fourth Edition | |
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Introduction | |
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Administration and Intake Forms | |
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Introduction | |
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Screening Information | |
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Notice of Appointment | |
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Consent to Treatment and Recipient's Rights | |
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Recipient's Rights Notification | |
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Financial Policy | |
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Payment Contract for Services | |
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Code of Ethics and Mission Statement | |
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Therapist's Ethics Statement | |
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Agreement Regarding Minors | |
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Preauthorization for Health Care | |
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Confi dentiality Agreement | |
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Forms Designed for HIPAA Compliance | |
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Introduction | |
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Privacy of Information Policies | |
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Request to Amend Health Records | |
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Request for Restricted Use/Disclosure of Records | |
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Request for Alternative Means of Confidential Information | |
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Release of Information Consent | |
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Record of Requests for Client Information | |
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Request for Listing of Disclosures of Client Records | |
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Screening Information | |
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Mental Health Screening Form | |
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Substance Abuse Screening Form | |
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Adaptive Functioning Screening Form | |
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Learning Disability Screening Form | |
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ADHD Screening Form | |
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Assessment Forms | |
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Introduction | |
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Initial Assessment-Adult | |
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Example of Completed Form | |
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Initial Assessment-Children and Adolescents (_18) | |
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Example of Completed Form | |
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Personal History-Adult (18_) | |
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Example of Completed Form | |
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Personal History-Children and Adolescents (_18) | |
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Example of Completed Form | |
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Couple's Information Form | |
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Emotional/Behavioral Assessment | |
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Example of Completed Form | |
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Emotional/Behavioral Update | |
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Example of Completed Form | |
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Diagnostic Assessment Report | |
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Example of Completed Form | |
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Diagnostic Assessment-Lower Functioning | |
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Example of Completed Form | |
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Biopsychosocial Report | |
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Example of Completed Form | |
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Psychological Evaluations | |
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Introduction | |
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Psychological Evaluation-Adult | |
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Example of Completed Form | |
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Psychological Evaluation-Children and Adolescents | |
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Example of Completed Form | |
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Psychological/Vocational Assessment | |
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Neuropsychometric Consultation | |
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Treatment Planning Forms and Procedures | |
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Introduction | |
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Individual Treatment Plan | |
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Example of a Poor Treatment Plan | |
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Example of Completed Form-Adult | |
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Example of Completed Form-Children and Adolescents | |
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Short-Term Therapy Treatment Plan | |
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Example of Completed Form | |
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Treatment Review | |
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Example of Completed form | |
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Treatment Update | |
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Example of Completed Form | |
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Progress Notes | |
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Introduction | |
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Example of Poor Progress Notes | |
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Example of Completed Form-Adult | |
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Example of Competed Form-Children and Adolescents | |
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Progress Notes-Outline | |
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Example of Completed Form | |
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Group Therapy Progress Notes | |
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Example of Completed Form | |
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Psychiatric Medication Management Progress Notes | |
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Other Forms Used during the Course of Treatment | |
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Introduction | |
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Referral for Mental Health Services | |
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Informed Consent for Medication | |
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Suicide Contract | |
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Cooperating in Child Rearing | |
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Couple's Analysis of Target Behaviors | |
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Example of Completed Form | |
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Third-Party Prior Authorization Request for Continued Services | |
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Example of Poor Authorization Request | |
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Example of Completed Form | |
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Chart Review and Outcomes Documentation | |
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Introduction | |
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Chart Review | |
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Utilization Review Committee Guide to Review Charts for Audit | |
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Utilization Review Committee-Chart Review Summary | |
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Medical Records Audit Chart | |
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Statement of Confidentiality for Those Auditing or Reviewing Client Charts | |
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Outcome Survey for Adults | |
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Outcome Survey for Children | |
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Outcome Survey for Families and Relationship | |
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Termination and Aftercare | |
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Introduction | |
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Discharge Summary | |
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Example of Completed Form | |
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Termination Letter | |
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Bibliography and Suggested Readings | |