Current through Register No. 50, December 12, 2024
Section He-M 408.06 - Intake Assessment(a) The CMHP shall complete and document an intake assessment for each individual.(b) The intake assessment shall: (1) Include medical, psychiatric, and social information;(2) Include historical and current information and assessments; and(3) Serve as a basis for ISP development.(c) The components of an intake assessment shall include, at a minimum; (1) Medical information including: a. A statement of the individual's general physical health status;b. Medical history, including current weight, height, blood pressure, pulse, and smoking status;c. When applicable, medical diagnoses, and the results of any medical or neurological screenings, examinations, or tests; andd. The name and contact information for the individual's primary care physician;(2) Psychiatric information including: a. History of mental illness or serious emotional disturbance, including onset and severity;b. Previous services and treatments, including medications and hospitalizations;c. Individual's strengths;d. Illness self-management skills;e. Precipitating events for current psychiatric symptoms, as applicable;f. Documentation of the medical necessity for services;j. Results of formalized psychiatric and/or psychological tests, if applicable;k. Mental status examination results; andl. Diagnostic formulation by a psychiatrist or other licensed practitioner of the healing arts under the auspices of a psychiatrist licensed to practice in the state of New Hampshire; and(3) Social information including:a. Developmental history;b. Educational history and current status, if applicable;c. Family history and current family status;d. History of childhood abuse and neglect;e. History of trauma, including domestic violence;f. Results of a substance use screening tool;g. Employment history including work skills and types, and lengths of employment;h. Military history and veterans status, if applicable;i. Current living situation including type of environment and nature of relationship with any room/house mates or family;j. Social and leisure time activities and skills;k. Ability to develop and maintain friendships;l. Involvement with or history of involvement with other social service agencies or the criminal justice system;m. Guardianship, if applicable; andn. Other legal documents.(d) Intake assessments that are completed to function as the initial ISP shall include the initial services to be provided and a physician's signature.(e) The intake assessment and updates shall be signed and dated by the person completing the assessment.N.H. Admin. Code § He-M 408.06
#7281, eff 5-23-00, EXPIRED: 5-23-08
New. #9512, eff 7-9-09
Amended by Volume XXXVII Number 45, Filed November 09, 2017, Proposed by #12409, Effective 10/24/2017, Expires 10/24/2027.