NYSCRI - MTM Change Initiative 2010

Forms/Manuals Download Section

Web Links:

Form set Overview: The New York State Clinical Records Initiative (NYSCRI) lead to the creation of a standardized set of clinical record forms that can be used by outpatient, day, and residential programs (for both adults and children) which are regulated by the New York State Office of Alcoholism and Substance Abuse Services and the New York State Office of Mental Health. These standardized forms will provide more uniformity for provider staff, improve documentation, facilitate movement between various levels of care as well as reduce the investment in maintaining records over time. This site contains downloadable program specific forms, manuals and support materials which can be used by participating providers.

All Forms Download Area

Download Key:

Paper: Please utilize this link to access the Adobe PDF® version of the form for those members who will be printing the forms and entering information manually by hand.

E-Form: Please utilize this link to access the Microsoft Word® version of the form for those members who will be entering information into the forms electronically.

Manual: Please utilize this link to access the support manual specific to this form.

** NOTE (11-1-12): the manuals posted are for the the 1st generation forms. All Manuals for the new forms are being updated by the OMH and will be uploaded as soon as they are completed.

Core Forms

Paper

E-Form

Manuals

All Assessments for Download Revision Date: 1-17-13
	Personal Information Revision Date:*11-1-12*
	Personal Information Update Revision Date:*11-1-12*
	Immediate Needs Assessment Revision Date: *11-1-12*
	Comprehensive Assessment (CA) Revision Date:*11-1-12*
	CA Update Revision Date: *11-1-12*
	Communicable Disease Assessment Revision Date:*11-1-12*
	Brief Medical History Revision Date: *11-1-12*
	Psychiatric Evaluation Revision Date:*11-1-12*
	Psychiatric Evaluation Update Revision Date:*11-1-12*
	Medication List Revision Date:*11-1-12*
	Psychiatric Rehabilitation Readiness Determination Revision Date:*11-1-12*
	Case Management Assessment Revision Date: *11-1-12*
	Case Management Assessment Update Revision Date: *11-1-12*
	Residential Intake Assessment Revision Date: 2-11-13 (Formatting Only, No Content Changes)
	Residential Functional Assessment - Adult Revision Date:*11-1-12*
	Residential Functional Assessment - Child Revision Date:*11-1-12*
	Self-Assessment Revision Date:*11-1-12*	Being Finalized
	Substance Use Assessment Revision Date:*11-1-12*	Being Finalized
	Summary List (Joint Commission - Clinics Attached to Hospitals) Revision Date:*11-1-12*	Being Finalized
All IAPs for Download Revision Date:*11-1-12*
	PAPER - Individualized Action Plan (IAP) Revision Date:*11-1-12*
	PAPER - Individualized Action Plan - Additional Goal Sheet Revision Date: *7-24-13 (Formatting Only, No Content Changes)*
	ELECTRONIC Only - Individualized Action Plan 1 Goal Revision Date:*11-1-12*
	ELECTRONIC Only - Individualized Action Plan 2 Goal Revision Date:*11-1-12*
	ELECTRONIC Only - Individualized Action Plan 3 Goal Revision Date:*11-1-12*
	ELECTRONIC Only - Individualized Action Plan 4 Goal Revision Date:*11-1-12*
	IAP Review/Revision Revision Date: *11-1-12*
	Psychopharmacology Plan Revision Date: *6-7-13 (Formatting Only, No Content Changes)*
	Psychopharmacology Plan Review Revision Date: *11-1-12*
	Relapse Prevention Plan Revision Date:*11-1-12*
	Discharge Summary/Plan - Part A Revision Date:*11-1-12*
	Below OASAS IAPs Only
	Discharge Summary/Plan - Part B Revision Date:*11-1-12*	Being Finalized
	OASAS Only – Functional Area Form Revision Date: *2-11-13 (Formatting Only, No Content Changes)*	Being Finalized
All PNs for Download Revision Date:*11-1-12*
	Pre-Admission Note Revision Date:*11-1-12*
	Contact Note Revision Date: *11-1-12*
	Coordination of Care Note Revision Date:*11-1-12*
	Session Note Revision Date:11-1-12
	Daily/Shift Note Revision Date: *11-1-12*
	Group Note Revision Date: *11-1-12*
	Nursing Note Long Revision Date:*11-1-12*
	Nursing Note Short Revision Date:*11-1-12*
	Admission Note - OMH Residential Only Revision Date: *11-1-12*
	Partial Hospital Note Revision Date: *11-1-12*
	Progress Summary Note Revision Date:11-1-12
	Admission Decision - PROs Revision Date: *11-1-12*	Being Finalized
	Psychopharmacology-Psychotherapy Note Revision Date:11-1-12
	Psychopharmacology-Psychotherapy Note - ACT Only Revision Date:11-1-12
	Below OASAS PNs Only
	OASAS Initial Determination/Level of Care/ Admission Decision Revision Date:11-1-12	Being Finalized
	OASAS Outpatient Rehabilitation Services Progress Note Summary Revision Date: 11-1-12	Being Finalized

Assessment Addendums

Paper

E-Form

Manuals

	Legal Involvement and History Addendum Revision Date:*11-1-12*
	Legal Status Addendum Revision Date:*11-1-12*
	Mental Status Exam Addendum Revision Date: *1-17-13 (Formatting Changes Only, No Content Changes)*
	Military Addendum Full Length Revision Date:*11-1-12*
	Military Addendum Significant Others Revision Date:*11-1-12*

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