Contract SV01 824 Perform standardized development Performance Case Notes screening by age 1 year (or referral to CFC Standard RF01/RF03 is made and followed). If receiving EI 80% services, Dev screening not required but document EI assessment date on SV01. Ages & Stages Questionnaire or any approved screening tool by IHFS Handbook for Providers of Healthy Kids. Cornerstone Referrals screens: Contract Referrals of participants to appropriate Case Notes Performance providers within the community for – CM04 &/9r Standard services identified in the individual care Service 100% plan and documented on the RF01. Provider WIC Selection Family Planning (RF01, RF03) Perinatal depressions screening if CM02, CM03 not provided by FCM agency Linkages/Referral Agencies Other: Intimate Partner Violence, Substance Abuse, Housing, etc. Document referral follow-up on RF01: RF01/RF03 WIC Or by agency FP approved policy Perinatal depression screening Linkages/Referral Agencies Other: Intimate Partner Violence, Substance Abuse, Housing, etc 3. EI Referrals are completed on all Infants Performance CM02:814, All referrals are to be recorded on the RF01 Screen. Use the comment line of the RF01 Screen to document follow Standard 100% CM03, CM04 or and children 0-3 indicated by dev up. Or documented by agency approved policy. approved policy screening, including follow-up.
Perform standardized development screening by age 1 year (or referral to CFC is made and followed). If receiving EI services, Dev screening not required but document EI assessment date on SV01. Ages & Stages Questionnaire or any approved screening tool by IHFS Handbook for Providers of Healthy Kids. Contract Performance Standard 80% SV01 824 Case Notes RF01/RF03 Referrals Referrals of participants to appropriate providers within the community for services identified in the individual care plan and documented on the RF01. WIC Family Planning Perinatal depressions screening if not provided by FCM agency Linkages/Referral Agencies Other: Intimate Partner Violence, Substance Abuse, Housing, etc. Contract Performance Standard 100% Cornerstone screens: Case Notes – CM04 &/9r Service Provider Selection (RF01, RF03) CM02, CM03 RF01/RF03 Or by agency approved policy Document referral follow-up on RF01: WIC FP Perinatal depression screening Linkages/Referral Agencies Other: Intimate Partner Violence, Substance Abuse, Housing, etc 3. EI Referrals are completed on all Infants and children 0-3 indicated by dev screening, including follow-up. Performance Standard 100% CM02:814, CM03, CM04 or approved policy All referrals are to be recorded on the RF01 Screen. Use the comment line of the RF01 Screen to document follow up. Or documented by agency approved policy.
FY17_FCM_Clinical_Review_Tool.docx