*What specific condition will be treated (i.e., a thought disorder, depression)? *What is the history and course of the condition? Describe etiology of current behavior concern. What are the target symptoms to be treated and what interventions may be effective in residential? Describe how the requested service fits within the standards of Clinical Practice Guidelines Standards. Describe how the requested service meets the medical necessity criteria. List the current services and impact on condition. child’s
*What specific condition will be treated (i.e., a thought disorder, depression)? *What is the history and course of the condition? Describe etiology of current behavior concern. What are the target symptoms to be treated and what interventions may be effective in residential? Describe how the requested service fits within the standards of Clinical Practice Guidelines Standards. Describe how the requested service meets the medical necessity criteria. List the current services and impact on child’s condition.