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Physician Certification Form |
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Manual: Behavioral Health Partial Hospitalization Program Policy and Procedure Manual (Ver 2)
As the health care industry’s most comprehensive library of customizable policy and procedure templates, MCN Healthcare’s Behavioral Health Partial Hospitalization Program Policy and Procedure Manual includes this customizable template, Physician Certification Form. MCN’s policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more. Health care organizations around the world utilize MCN’s compliant ready templates and workflow process tools to help them meet the latest changes in regulations and standards. Here is some sample content from Physician Certification Form:
| | PHYSICIAN CERTIFICATION
Patient Name:
CERTIFICATION - ADMISSION
I certify that the patient would require inpatient psychiatric care if the partial hospitalization services were not provided and services will be furnished under the care of a physician, and under a written plan of treatment.
Physician:
RE-CERTIFICATION Every 30 days
I certify that continued partial hospitalization services are medically necessary to improve and/or maintain the patient's condition and functional level and to prevent relapse or hospitalization.
Physician:
RE-CERTIFICATION Every 30 days
I certify that... |
| Second excerpt: |
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RE-CERTIFICATION Every 30 days
I certify that continued partial hospitalization services are medically necessary to improve and/or maintain the patient's condition and functional level and to prevent relapse or hospitalization.
Physician:
RE-CERTIFICATION Every 30 days
I certify that continued partial hospitalization services are medically necessary to improve and/or maintain the patient's condition and functional level and to prevent relapse or... |
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