YES NO NA Evidence that DDA and MH systems are communicating on treatment approach Evidence of DDA and community MH participation during hospitalization After the last state hospital discharge (civil commitment), were discharge summary (and HMH, if available) recommendations followed in the community? If no, is rationale in the individual record? Do the records clearly reflect collaboration with others, key community support agencies (e.g., DOC, law enforcement, healthcare providers, etc.)? GENERAL OBSERVATIONS FINDINGS CORRECTIVE ACTION REQUIRED (Specify sources, include completion dates) DDA QUALITY COMPLIANCE REVIEW REVIEWER DATE OF REVIEW (Specify sources, include completion dates) BHO / MENTAL HEALTH REVIEW REVIEWER DATE OF REVIEW INSTRUCTIONS Timeframes: 3RD 1ST QUARTER 2ND QUARTER 4TH QUARTER QUARTER REVIEW REVIEW REVIEW REVIEW Identify participant December 1 1 June 1 September 1
YES NO NA Evidence that DDA and MH systems are communicating on treatment approach Evidence of DDA and community MH participation during hospitalization After the last state hospital discharge (civil commitment), were discharge summary (and HMH, if available) recommendations followed in the community? If no, is rationale in the individual record? Do the records clearly reflect collaboration with others, key community support agencies (e.g., DOC, law enforcement, healthcare providers, etc.)? GENERAL OBSERVATIONS FINDINGS CORRECTIVE ACTION REQUIRED DDA QUALITY COMPLIANCE REVIEW (Specify sources, include completion dates) REVIEWER DATE OF REVIEW BHO / MENTAL HEALTH REVIEW (Specify sources, include completion dates) REVIEWER DATE OF REVIEW INSTRUCTIONS Timeframes: 1ST QUARTER REVIEW 2ND QUARTER REVIEW 3RD QUARTER REVIEW 4TH QUARTER REVIEW Identify participant December 1 1 June 1 September 1
10-349.docx