Optum San Diego - Home
Concurrent Review Guide
for COUNTY FUNDED SNF
|Review Date: | |
|Facility Name: | |
|Doctor’s Name: | |
|Client Name: | |
|Client DOB: | |
|Date Admitted: | |
Required attachments:
• Monthly Psychiatrist Notes for period being reviewed
1. Current ICD 10 diagnoses
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2. Medication changes (since admit or since last review)
|Name |From Dosage |To Dosage |Dosing Schedule |Date of Change |Reason for Change |
| | | |(am, bid, etc.) | | |
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3. Current medications not included above. Do not include PRNs.
|Name |Dosage |Dosing Schedule |Date started |Reason/ Symptom addressed |
| | |(am, bid, etc.) | | |
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3. Psychiatric PRN medications administered in review period
|Name |Dosage |Times taken per |Date started |Reason/Symptom addressed |
| | |month | | |
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4. High risk behaviors in review period
|Behavior Type |Number of Incidents since last review |Intervention applied and client response |
|Assault | | |
|Property Destruction | | |
|Threats | | |
|AWOL behavior | | |
|Sexual acting out | | |
|Use of seclusion | | |
|Use of restraints | | |
|Other | | |
5. High risk medical issues/ exacerbations of chronic medical issues
|Medical disorder |Number and type of incidents since last |Intervention applied and client response |
| |review | |
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6. Completion of ADLS/ showers/ bathing/ clothing/ meals
|Behavior |With or without assistance |Average completion per week |
|ADLS | | |
|Showers/Bathing | | |
|Clean appropriate clothing | | |
|Meals | | |
7. Participation in program activities/ groups
|Activity |Average number of times per week |Participation level |
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8. Summary of client’s presentation/progress/interventions used:
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9. Current discharge planning. Include any barriers to discharge.
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Please fax completed review to:
Optum
(888) 687-2515
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