Avatar Clinicians Manual

Transcription

1 Avatar Clinicians Manual NEW! Look for the green highlights for additions and updates. 1 P a g e

2 Introduction This manual was written for Santa Cruz County mental health clinicians and provides basic information on how to use Santa Cruz Avatar documents. It is continually updated as changes are made to Santa Cruz Avatar. You should check back periodically for changes and updates. In this version of the manual, new updates and information are highlighted in Green. The manual provides information on use of Avatar forms. Clinical information (i.e. what to write) is not specifically covered. You should consult with your supervisor or the QA department for more information about clinical content. On the Santa Cruz County Avatar Website, you will find a copy of this document along with supporting documentation on other specialized topics such as Psychiatry Progress Notes, Supervisor information and Group Progress Notes. 2 P a g e

3 How to Use this Document In order to find specific information in this document, you can use the table of contents or you can search for any word or phrase. In the table of contents (next page), click on any subject and you will be taken to the appropriate page. Another way to search for information is to search a word or phrase, by clicking [crtl] + [F]. Type in your word or phrase into the blank and click "enter" on your keyboard to go to that word or phrase. (This works on any page on the Internet.) To find an electronic version of this document, go to the Santa Cruz Avatar webpage at You can also navigate to the County Avatar website by typing Avatar Resources into the Search Forms blank on your Forms Widget. If you click in the link, this will take you to the website. On the Website, search for the Avatar Clinicians Manual and other helpful documents. 3 P a g e

4 Table of Contents Logging In to Avatar...10 System Codes by Program...11 If You Forget Your Password...12 Screen Sign Out...12 To Change Your Current Password...12 Java Errors and Problems Logging In...15 Quick Tips and Shortcuts...20 Spell Check and Automatic Correction...20 Avatar Help and Other Resources...23 Avatar Home View and Menu Bar...24 Widgets...26 Widget Features and Changing Your Widget Setup...26 How to Reset Widgets...28 If there is a form that you think you should have access to, but you cannot find it...31 I can t find my Recent Clients...34 Non-Caseload Access Warning...35 Widgets...35 The My To Do s Widget...35 My Calendar Widget...36 Service Request and Disposition Log Widget...36 Service History Widget...37 Progress Note Widget...38 My Pending Notes 60 Days Widget...39 Client Episodes Widget...39 Reports...39 Current Caseload Report...40 Psychosocial Assessment Report...41 Chart Views...41 To Open a Chart...41 Chart Overview P a g e

5 Inquiry View...44 Admission Programs vs. Episodes...45 How to Scroll Through Chart Tabs...47 Add a Form That is Not Listed to Your Chart View...48 To Print from the Inquiry View...52 Printing Scanned and Routed Documents...54 Staff Messaging...54 Pre-Display...54 To Retrieve or Open a Message That Has Been Sent to You...57 Notification Users Form (If you don't have anyone to send messages to)...59 Caseload Assignment: How to Have a Client Added to Your Caseload...61 Caseload Assignment Request Instructions...62 To Have a Client Added to Your Caseload...62 To Have a Client Removed From Your Caseload...62 Understanding Client Admissions and Workflow Through the System...63 Admission Programs and Service Programs...63 Mental Health Programs...63 Substance Use Disorder (SUD) Programs...64 Client Registration & Financial Admission Program...65 County Pre Admit Outpatient Admission Program...65 Service Request and Disposition Log (SRADL)...67 Admission Form...67 Search for the Client...67 CLIENT REGISTRATION & FINANCIAL Admission Program...73 CSI Admission and Cal-OMS Admission...76 CSI Widget...77 Update Client Data form and CSI Information form...77 Wait List Management...77 List Detail Section...82 Wait List Management Report...83 Onset of Services form (Consents)...84 How This Document Works...84 Consent for the Exchange of Confidential Mental Health and Substance Use Disorder Treatment Information tab...85 Consent for Mental Health Treatment tab...89 Consent for SUD Services tab P a g e

6 Notice of Privacy Practices (HIPPA form)...91 Medicare Payment Authorization...91 Private Insurance Authorization...91 Guide to Medi-Cal Mental Health Services...92 Avatar Assessments: General Concepts...92 Psychosocial Assessment General Concepts...94 Santa Cruz Psychosocial Assessment Form...97 Presenting Problem Tab...98 Culture/Spirituality Tab Mental Health Hx Tab For Non-LPHA s: Where to put the MSE and Diagnosis Risk Factors Tab Legal History Tab Medical Information Tab Client Resources Form Developmental History Tab CRAFFT/CAGE AID Tab CRAAFT section (for children/youth) CAGE AID section (for adults) Substance List Tab Substance Use Hx Tab Trauma History Tab Strengths Tab Summary Tab Where is the diagnosis? How do I bill for the service? Finalizing and Submitting the Psychosocial How to Reopen a Draft Psychosocial Assessment Form Open a Draft Psychosocial Assessment from your Home Console Open a Draft Psychosocial Assessment from the Chart How to View a Completed Psychosocial Assessment in the Chart How to Print a Psychosocial Assessment Form Psychosocial Assessment Updates To select an assessment from which to auto populate your new assessment Risk Assessment Form Mental Status Exam (MSE) Form P a g e

7 CANS/ANSA Form To Print a Copy of Your CANS/ANSA ASAM Form ASI Form Admission Diagnosis When to complete the Diagnosis form To View a Client s Current Diagnosis Diagnosis Update To Resolve a Diagnosis Scheduling Calendar Scheduling an Appointment in the Scheduling Calendar To Delete Multiple Appointments in a Series To Adjust One Appointment in a Series Scheduling Calendar vs. the My Calendar Widget Finding an Existing Appointment in the Scheduling Calendar Finding a New Appointment in the Scheduling Calendar Staff Daily Schedule: Print Out Your Appointments for One Day Staff Weekly Schedule: Print Out Your Appointments for One Week Progress Notes Opening a New Progress note Writing a New Progress Note How Do Supervisors and Approvers Work in Document Routing? Print a Copy of a Progress Note Writing a progress note to document your service for an Assessment or Treatment Plan How to Tell If There are Draft Progress Notes in a Chart Reopening a Draft Progress Note What To Do if the Link to Your Draft Progress Note is Missing From the Chart How to Delete a Draft SC General Purpose Progress Note or SC Med Service Progress Note How to Delete a Draft SC Group Progress Note Using the Append Progress Notes Form to Add to a Progress Note Group Progress Notes Indirect (MAA) Service Note Shared Treatment Planning Treatment Plan Types in Santa Cruz Avatar P a g e

8 There are three current treatment plan types in Santa Cruz Avatar as discussed below. You will use one of these forms to create your treatment plans SC MH Episodic Treatment Plan SC SUD Treatment Plan SC MH Short Term Treatment Plan (OLD) SC MH Treatment Plan SC MH Episodic Treatment Plan Overview Steps in Creating Sequential Integrated Plans Definition of Legal Entity or LE Integrated Treatment Planning and Due Dates for the SC MH Episodic Treatment Plan Plan Page and Plan Builder Page Treatment Plans for Monolingual Clients BEFORE YOU START YOUR MH EPISODIC TREATMENT PLAN Creating an Initial MH Episodic Treatment Plan Plan Naming Conventions Problems Table Plan Builder Page Use the Electronic Signature Pad to Obtain Signatures Printing a Copy of Your Treatment Plan Printed Treatment Plan Workflows (what to do if you don t have a signature pad) Creating a Treatment Plan Update (Defaulting Plan Data from a Prior Plan) IF YOU MAKE A MISTAKE WITH YOUR AUTHORIZATION START DATE Add New Goal(s), Objective(s), and/or Intervention(s) to Your Update Remove and Resolve Problems, Goals, Objectives and Interventions That Are Not Needed How to Correct When You Have Selected the Wrong Problem in a Treatment Plan Creating an Annual Treatment Plan Who does the Annual Plan first? Collaborating to Obtain Signatures for Shared Plans Document Routing Refresher How Do Supervisors and Approvers Work in Document Routing? STEPS (Procedure) Questions How Many Goals, Objectives and Interventions Should I Add in a Shared Plan? When Are Treatment Plans Due? P a g e

9 How to Add Your Service Program Information to an Intervention (OPTIONAL) Discharging Clients Corrections: What To Do If You Make a Mistake Corrections Definitions Episode (Admission Program) Number Client Number Service Date Data Entry Date Data Entry Time Total Duration Time Reason (for deleting note or making changes) Is this a group note? (Y/N) Individual Progress Note Corrections Group Progress Note Corrections Group Progress Note Deletions Group Progress Note Data Changes Treatment Plan Deletions Reverting Treatment Plans to Draft Reverting Other Documents Draft Re-Opening Episodes Deleting Episodes If you have added a document other than a progress note to the wrong Admission Program or LE Scanning Errors I have A LOT of corrections. Can I put them in a spreadsheet instead? I finalized a document and forgot to route it to my supervisor. Can it be routed to her? P a g e

10 Logging In to Avatar 1) Open the Link to Avatar: You can do this a few different ways. a. Click on the Avatar icon located on your desktop. b. Alternately, you can enter the web address into your browser directly. For the LIVE environment, it is For the UAT environment (our testing and training environment) it is Make sure that you are logging into the correct environment. UAT is different than LIVE. 2) Once have navigated to the website, the Avatar launch page will open. Click Start Avatar. 3) IF AVATAR DOES NOT LAUNCH, see the section titled Java Errors for more information. 10 P a g e

11 4) To log in: a. Enter your System Code (all caps). For example, LIVEMH or UATEN. Note that your system code is determined by your agency and your role. The system code is different for different users. See below for a list of System Codes. b. Enter your username (lowercase). This will be the first 6 letters of your last name (or less if your last name is shorter than 6 characters) followed by the first letter of your first name. example: Mike Coopertown would be cooperm. (There may be some exceptions to this rule. See your supervisor or the computer help desk if you think you may have a different log in name.) c. Enter your Password (case sensitive). For your first log in, you will be given your password. d. If this is your first login, you will be immediately prompted to change your password. Your password must be 8 characters long. It may contain special characters (#$%&) and numbers. It is recommended that you use special characters to ensure password security. e. Once you have entered your Username and Password, Click Sign In. System Codes by Program Agency/Program System Code Suffix UAT System Code LIVE System Code Encompass ADP EN UATEN LIVEEN Janus JN UATJN LIVEJN New Life NL UATNL LIVENL PVPSA ADP PV UATPV LIVEPV Sobriety Works SW UATSW LIVESW All Agency MH Programs (Encompass, Front St., PVPSA, Parent Center, County, etc ) MH UATMH LIVEMH 11 P a g e

12 If You Forget Your Password After five tries, Avatar will deactivate your user account and you will no longer be able to log in, even with your correct password. If this happens, your supervisor or an IT person can either reactivate your account so you can try again, or they can set a new password for you. If your supervisor or someone else at your agency cannot help you, contact the computer helpdesk at x4657 or hsamhhelp@co.santa-cruz.ca.us Screen Sign Out If you need to step away from your desk, remember to sign out by clicking on Sign Out located in the upper right-hand corner of your screen. This will prevent unauthorized users from viewing client information in Avatar (HIPAA). Always save when possible to avoid losing work to any surprises such as power surges. You will lose any unsaved data when you sign out, so make sure you save and close all open forms. To Change Your Current Password 1) Locate the Forms & Data widget on your home view. 12 P a g e

13 2) Click in the Search Forms field and type Change Current Password. Double click on the form name to open up the form. 3) Once you have opened up the form, in the Current Password field, enter your current password. 4) In the New Password field, enter your new password. 5) In the Re-Enter New Password field, enter your new password again. 6) On the left hand side of the screen, click on the Submit Button. 13 P a g e

14 Submit Button Throughout Avatar, you will see the Submit button on most forms (or the File button for progress notes). Submit = Save & Close. DO NOT click the red and white "X". close without saving your data. If you do this, the form will 14 P a g e

15 Java Errors and Problems Logging In Depending on recent updates, Avatar might not run on the most recent version of Java. If your computer prompts you to update your Java, DO NOT UPDATE JAVA without checking with your supervisor or an IT person. Avatar might not run if you do this. As of the publication date of this manual, the Java version that Avatar needs to run is: Version 8 Update 121 If you think you need to update Java anyway, consult your IT person before proceeding. If you see the warning below, your Java may not be not set up properly. 15 P a g e

16 Try restarting Avatar and make sure you click Run this time, at the Java Prompt. 16 P a g e

17 You may see another Java Update prompt. If you do, click the checkbox where it says, "Do not ask again until the next update is available." Then click, "Later." If you see the message at right, click Allow. 17 P a g e

18 If you receive the popup below, click Save and then click Open. If Avatar is telling that you need to update Java (seen usually at the login screen), you can try make these messages disappear: 1. Go to the Avatar login screen. 2. Go to the go to Tools Internet Options 3. Click on the Security Tab Trusted Sites Click on Sites 18 P a g e

19 You should see the Avatar address in the window that appears (shown below is the UAT address, you may want to enter the LIVE address). Click on Add, then click Close. 19 P a g e

20 If none of these steps help or if you need further assistance, contact your IT department or the computer helpdesk at x4657 or Quick Tips and Shortcuts 1) Lightbulbs on forms: These symbols are a link to helpful information about filling in a particular question or field. 2) You can use the space bar to check or uncheck a box in a list field. 3) In a list field, use the arrow keys to move back and forth between check boxes. 4) On Home Console, you can click once on Client to select the client, and then go and search for a form to pull up with that Client (works on most forms). 5) Most forms that have a name search field require you to do the search by entering the last name. You can also use the Client number or practitioner number in name search fields. 6) In date fields, you can use T for today instead of entering a date. You can also use Y for Yesterday, T-30 for 30 days in the past. 7) To clear a radio button, checkbox or list item in a question (you want the question to be totally blank), click any of the buttons in the question, then click F5, which will clear the field. If you have done this right, none of the buttons in this field will be clicked. If this is a list item type question, the question will appear blank. Spell Check and Automatic Correction Avatar has spell check that you can use in most fields. Misspelled words will have a red, wavy line underneath them. 20 P a g e

21 You can right-click on the misspelled word to pull up a menu of spellings. Left click on the one you want. To add a word to the dictionary, click Add. You can also press F7 on your keyboard to call up spell check. You can create a shortcut phrase for longer words and phrases that you use regularly. (This is similar to how autocorrect works in Microsoft Word.) To use this feature, go to Preferences, in the upper right of your home screen. Note: If you set this up, be sure to use codes that are not common in regular language or contained within a word, otherwise when you do your spell check you may add phrases in places you do not want them to be! Note: this will only work on the machine that you have set up the dictionary on. 21 P a g e

22 There may be times when you want to cut and paste text from another document into Avatar. When you do this, you might get a lot of red wavy lines underneath your pasted text. Avatar thinks these are spelling errors. To get rid of the red lines, first, press F7 to call up spell check. Then, click Ignore all multiple times to get rid of the red lines. When you are done, a popup will appear letting you know that spell check is complete. Click OK. 22 P a g e

23 Avatar Help and Other Resources 1. Your first source of support should be your supervisor or other Superusers at your agency or in your workgroup. A Superuser is someone who has had extra training in Avatar and may be able to help you. 2. County Trainings are offered regularly. Watch for s and the Avatar Bulletin for more information. 3. QI (AskQI@santacruzcounty.us) 4. Computer help desk (HSA.MhCompAssist@santacruzcounty.us) 5. Written documentation posted on the County Avatar website You can also navigate to the County Avatar website by typing in Avatar Resources into the Search Forms blank on your Forms Widget. If you click in the link, this will take you to the website. On the Website, search for the Avatar Clinicians Manual and other helpful documents. 23 P a g e

24 Avatar Home View and Menu Bar Home View: Once you launch Avatar, the first screen that will appear is the Home View. You will see rectangles called Widgets arrayed on your desktop. Widgets show various types of information from Avatar. (See the Widgets section below for more information.) 24 P a g e

25 Menu Bar: The Menu Bar, located at the top of the Avatar Home screen, allows you to navigate between Forms, Chart Views, and your Home view. The Menu Bar contains the Home Button that will return you to your Home View. No matter where you are within the system, the Menu Bar displays any Forms or Charts that you have open. You can have multiple forms and charts open at once and they will all be listed here so you can toggle back and forth between them and the home view without using the windows task bar. The Menu Bar also contains your Preferences and Help menus. The User ID that is logged in is displayed in the upper right hand corner. Consoles or Multiple Home Views: Depending on how your access is set up, you may have more than one view. These views are known as Consoles and are displayed in a row next to My Views. To switch between views, just click on the Console name. In the example, the Home Console is selected (highlighted in green). 25 P a g e

26 Widgets Widgets are the small rectangles on your Home View and in the Chart Overview. Widgets show views of information from Avatar. Some Widgets provide handy views of commonly used information, like the Service History Widget. Other Widgets are interactive, like the My Calendar Widget and the My To Do s Widget. One way to think of a Widget is like a window or door in a house. If you look through the window, you can see into the house, although you cannot interact with anyone in the house. Some Widgets work like this. You can view information, but you cannot interact with it. Other Widgets are like a door, where information travels in and out of the house. They allow you to have interaction with the Avatar database. Widgets are assigned by Role and may vary depending on your access. A role is essentially a job category in Avatar. Examples of roles are FVLClinician, FVLPrescriber. Your Avatar Role determines which Home Console or Consoles you have and which widgets you have on your console(s). Your role also determines what forms you can work with, what you can view, which charts you can view, scheduling and many other functions. If there is a form that you think you should have access to, but you cannot find it, there may be something that needs to be changed in your setup. If you think that your setup needs to be changed, contact the computer helpdesk at x4657 or hsamhhelp@co.santa-cruz.ca.us Widget Features and Changing Your Widget Setup You can move widgets around on your desktop to a setup that is convenient for you and your workflow. Enlarge and Shrink Widgets Make widgets larger or smaller by clicking and dragging on the edges. For example, hover your cursor over the line between the Forms & Data widget and the Client Episodes Diagnosis widget until the cursor turns into a double sided arrow. Click and drag to the left or right to change the size of the two widgets. 26 P a g e

27 Turn a Widget into a Toggle Button at the Bottom of Your Home Console There are some widgets that you may not need to see most of the time. You can change them into a button at the bottom of your home screen to make space for the widgets you most commonly use. You can click this button to see widget contents. Click it again to close it. For example, you may not want to look at the contents of the Service Request and Disposition Log Widget all of the time. To change it into a toggle button, click on the little minus sign in the upper right hand corner of the widget. At the bottom of your Home console, see how the widget is now a rectangular button. If you click this button, the Service Request and Disposition Log opens up again. If you click the button a second time, the widget turns back into a button. Widgets that you use infrequently can be placed at the bottom of your Home Console so that they don t take up valuable real estate on your Home Console. 27 P a g e

28 Dock and Undock Widgets Sometimes, you might want to pop a widget out of your home console and create a separate window. 1. Click on the little curved arrow in the upper right-hand corner of the widget. 2. Click on the square in the upper right corner of the widget to enlarge it to full-screen. 3. To pop the widget back into your Home Console, click the curved arrow again. Use the Refresh Button to Update Data in a Widget The Refresh Button: Many widgets have a refresh button that you will need to click to update the widget. If you have made changes to any of the data displayed in a widget, you won t see it until you have clicked the refresh button. You will also find the refresh button in your client charts. If you write a progress note or fill out another type of form in Avatar, you won't be able to see it in the chart until you click the refresh button. Charts also have this refresh button. How to Reset Widgets If you have made changes to the layout of your widgets on your Home Console, or in Charts, and want to return to the default layout, do the following. 28 P a g e

29 1. On your Home Console, on the right side of the menu bar, up at the top of the page, click on the little checkerboard icon as shown below. This takes you to an area where you can reset your widgets to your default layout. 2. Click Reload Home View and then Apply to restore the widgets to their default layout. 29 P a g e

30 Forms & Data Widget This Widget allows you to access forms in Avatar. There are several ways to search for forms using this Widget. My Forms: Here, you will see a list of forms that have been assigned to you, based on your Role. This is a list of forms that you will likely use most often, but it does not include all forms you can use. See below for information on how to add a form to this list using the Edit feature. Recent Forms: If you have recently opened a form, it will appear in Recent Forms. Browse Forms: Click on Browse Forms to see a list of forms sorted by categories. Search for clinical forms in "Avatar CWS." Search Forms: You can also use the Search Forms box to find forms. Once you start typing, the matching forms will display dynamically. Adding Forms to My Forms: There are two ways to add a form to your My Forms list. 30 P a g e

31 1. You can click and drag a form from Recent Forms up to the My Forms section. 2. Or you can click on Edit, located in the upper right of the widget. Santa Cruz Avatar This will open a new window. Type in the name of the form that you wish to add, then click on Add Form. While in this window, you can also right click anywhere and add folders to organize your forms. Once you Right Click in the window, click Add Folder. If there is a form that you think you should have access to, but you cannot find it There may be something that needs to be changed in your setup. If you think that your setup needs to be changed, contact the computer helpdesk at x4657 or hsamhhelp@co.santa-cruz.ca.us 31 P a g e

32 My Clients Widget This Widget functions similarly to the Forms & Data Widget, with sections and links allowing different types of searches. My Clients: The clients assigned to you are marked with an arrow symbol, >. Your caseload is here. Recent Clients: Clients whose charts you have recently viewed. Note that this is not the same as clients assigned to your caseload. Clients in Recent Clients can be any clients that you have recently looked at whether or not they are on your caseload. Once you have opened a Client, the client s name will appear in your Recent Clients list until you end the current session in Avatar. Search Clients: Type in the last name or first name of your client to search. You will get a list of potential matches. Double click on the client name to open the chart. 32 P a g e

33 Advanced Search: Click on advanced to open up a window that allows a more targeted search for a client, with fields including DOB and SSN. You only have to have three pieces of data to search for the client. With many forms in Avatar, before opening the form, you will first be asked to select a client using a search box. 33 P a g e

34 I can t find my Recent Clients When you open Avatar, you might see something like this, where your recent clients area appears to be missing. If this is the case, hover your cursor over the area between the Recent Clients section of the widget and the My Clients section of the widget. Then, click and drag to expand the Recent Clients section. 34 P a g e

35 Non-Caseload Access Warning If a client is not on your caseload, when you open up the chart, you will get a warning that says that the client is not on your caseload. Avatar will not stop you from opening the chart, but you will have to state the reason why you are looking at it. Click, "Yes," and then enter the reason why you need to look at the chart. To stop this warning, have the client added to your caseload. See the section titled, "Caseload Assignment Request Instructions." The My To Do s Widget Widgets Your My To Do s will show you forms that are saved in draft mode (i.e. documents that you need to complete, like progress notes) and messages from other staff. Most items, except for simple messages, are associated with a task that you need to complete. You must complete the task, such as completing a draft progress note, in order for the item to go away. See the section on Staff Messaging for more information. 35 P a g e

36 My Calendar Widget Please Note: My Calendar Widget is NOT the Scheduling Calendar. The My Calendar Widget is for viewing existing Client appointments and for launching progress notes only. Scheduling appointments must be done through the Scheduling Calendar. The My Calendar Widget shows all the appointments you have on one day. Click on the arrows next to the date to move one day ahead or back. One benefit of the My Calendar Widget is that you can right click on a client s appointment and open the progress note form directly from your Home Console. The Progress Note form will be prepopulated with all of the appointment information, such as the client name, the date of the appointment and the service code. For more information about appointments, see the section on the Scheduling Calendar. Service Request and Disposition Log Widget This widget shows entries from what was previously called the Access Log or Call Logging. Note that the client must be selected or highlighted on your home console in order to view data in the widget. In the widget, clicking on the date (in blue) in an entry will take you to the call log and you can read what happened for a single call or contact. This widget is covered more thoroughly in the documentation for Access. 36 P a g e

37 Service History Widget This widget is on your Home Console. It is a quick view of recent services that you can conveniently access without having to open the client's chart. Note that a client must be selected (highlighted in green) in order to view the information in the Widget. Click once to highlight a client in your My Clients Widget (clicking twice will launch the chart, which you don't want to do with this case). A client must have already had some services, or the widget will be blank. 37 P a g e

38 Progress Note Widget This widget shows all of a selected client s progress notes. In the chart, progress notes are separated by Admission Program or Episode and can be filtered in a variety of ways. The Progress Note Widget compiles all notes from all mental health admission programs) and any substance abuse programs where the client has signed the County Exchange of Information). All notes are shown, in order, by entry date (not service date). The default for this widget is to show the last 30 days of notes. You can expand this range by typing in the number of days, and then pressing the TAB KEY. IMPORTANT: Remember to press tab after you type in the number of days or you won t be able to see all of the notes you want. (Pressing Enter won t work.) 38 P a g e

39 My Pending Notes 60 Days Widget This widget shows you any draft notes that you still need to complete. It only shows the last 60 days of notes. Draft notes that are older than 60 days won't be here. To find these older notes, you will have to look in the client chart. There isn't a link to the note in this widget. To open up the draft note you either need to find a link in your My To Do's, or find the note in the chart. See the section titled, "Reopening a Draft Progress Note," for more information. Client Episodes Widget This widget shows all of the Episodes or Admission Programs for this client. Each episode shows the opening date, as well as the closing date, if there is one. Closed episodes have both a closing and an opening date. Open episodes simply say, "Open Episode," where the closing date should be. Below, you can see that the client has been opened to a few different episodes. Episode #2 is closed. The other two episodes are still open. Reports Reports are another way to see information from Avatar. They are different from Widgets in that their information is static, but reports can be created at any time. Reports can have an arrays of information that can be useful for a supervisor or a manager, such as productivity information or team caseload information. Reports can also be printed versions of one document, such as a treatment plan or an assessment. 39 P a g e

40 Current Caseload Report This report shows you information for clients on your caseload. Enter the staff name and date range to get a caseload list with information about your clients. If you enter a supervisor name, the report will contain the caseloads of all staff associated with this supervisor. 40 P a g e

41 Psychosocial Assessment Report This report provides a formatted version of a psychosocial assessment. Although you can also print this form from the chart, this view is formatted. It also contains all questions on the assessment. The chart view only contains questions that have data in them. To Open a Chart Chart Views To open a chart, you must first select a Client. You can use the My Clients Widget to select one of the Clients in your My Clients list. You can also select a client in your Recent Clients list, or search for a new Client under Search Clients. Once you have located the Client you wish to open, double click on the name to open the Chart View. 41 P a g e

42 If a client is not on your caseload, when you open up the chart, you will get the Non-Caseload Access warning. Click Yes, and then type in why you are opening the chart in the next popup. Home Bar In the chart, at the top of your screen, is the Home Bar. It will always be there, no matter where you are in Avatar. It has links to charts and forms that you may have open. There is also a link back to your Home View. There are two main views in the chart, the Chart Overview and the Inquiry View. 42 P a g e

43 Chart Overview When you first open the chart, you will see an array of widgets and a list of forms on the left. This entire screen or view is called the Chart Overview. Some of the widgets you will see are also in your Home View. Other Widgets are unique to the Chart Overview. Depending on your role you may see a different array of widgets. 43 P a g e

44 Inquiry View Forms: In Chart Overview, you will see a list of forms to the left. If you click on one of these forms, you will see a view that shows you forms for a particular Admission Program. This is called the Inquiry View. If you need to enter information into a form that is not listed, you can open forms by clicking on the box that has a green cross on it. This will open the My Forms Widget (from your Home console). To add a form to the inquiry view that is not there, see the section titled, Add a Form that is Not Listed to Your Chart View. In the chart, the Inquiry View shows you all of the documents of a certain type. For example, by clicking on "SC General Purpose Progress Note, you can look through notes for a specific Admission Program. For progress notes only, the Inquiry View only holds one year's worth of documents. If you need to see notes that are more than a year old, use the Progress Note Widget. Once you have opened the Inquiry View for the form you want, for example SC General Purpose Progress note, click on your Admission Program. You will see a small "Add" in the upper right-hand corner. Click Add to open a new form. The Refresh Button: If you write a progress note or fill out another type of form in Avatar, you won't be able to see changes in the chart inquiry view until you click the refresh button. 44 P a g e

45 Program Tabs: In Inquiry View, you will see a set of tabs across the top of the Inquiry View. Each tab represents a different Admission Program. Make sure you click on the correct Episode when viewing documents. Similarly, when you open up a new form in the client's chart, make sure you have the correct Episode tab. If you have clicked on the wrong Episode, the document will be misfiled. Admission Programs vs. Episodes Sometimes Admission Programs are referred to as Episodes. These terms are often used interchangeably, but there is a difference between these two terms. An Admission Program is simply the name of the program. An Episode is a single instance of an admission program. There can be multiple episodes for a single admission program. For example, a client who is new to the system is opened to an Admission Program for the first time. Then, the client moves away and is closed entirely to services. Then, the client moves back and is for a second time to the same Admission Program. Each of instance of the opening (and later a closing) to an Admission Program is called an Episode. In the example described here, there are two Episodes of a single Admission Program. 45 P a g e

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47 How to Scroll Through Chart Tabs If the client has several programs in the chart, you won't be able to see all of the Episode tabs. Click on the very tiny triangles at the upper right to scroll back and forth among the chart tabs. To Enlarge Text in the Inquiry View At bottom right in the inquiry view, you will see a button that you can slide left and right to increase and decrease the size of the font in the inquiry view. This handy button is also on many forms. 47 P a g e

48 Add a Form That is Not Listed to Your Chart View If you need to add a form that is not listed in your Chart View, use the following procedure. 48 P a g e

49 Type in the word Diagnosis in the blank provided. A list of forms matching what you typed in will pop up. The diagnosis form is unique in that there are two form paths. Double click on the form that says, Avatar PM, under, Application. (If you select the CWS version, it won t stay in the chart. The PM version will.) 49 P a g e

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51 Click on Diagnosis to view diagnoses that have been added to the chart. 51 P a g e

52 To Print from the Inquiry View Many forms can be printed directly from the inquiry view. Some forms have a formatted report that you may prefer instead of printing from the inquiry view. The Psychosocial is an example of this. To print from the inquiry view, locate the form you want to print, and then click print at upper right. Note that the text in the inquiry view prints out quite a bit larger than what you see on the screen. Use the slider bar to adjust the view before printing. 85% gives you a printout with font size that is about 10 or 11 points. Routed vs. Scanned Documents Links to routed and scanned documents can be found in the chart in the Documents section at the bottom of the forms list. In the chart, in the Documents section, there are links to both scanned documents and document routing. Documents are arranged by category. Categories with a (DR) at the end are routed documents. Scanned documents start with a three letter designation such as LGL or CLN. If you don't see the Documents section at all, this means that there are no routed or scanned documents in this particular chart. You will only see the Documents section if there are documents in it. 52 P a g e

53 To View a Routed Document 53 P a g e

54 Printing Scanned and Routed Documents Santa Cruz Avatar Most people do not have the ability to print scanned and routed documents. If you need to print one of these documents, contact the QA department. Staff Messaging 1) Open the Staff Messaging Form: To send a message, you must first open the Staff Messaging form. Open the form in your Forms & Data Widget. 2) A window will appear called Select User ID/User Description. Type in your last name and then double-click on your name. IMPORTANT: You must TYPE IN YOUR OWN NAME, NOT THE RECIPIENT. The recipient is the person you are sending the message to. (Think of it as "logging in" so you can send your message.) 3) Click Add when you see the Pre-Display for the form. Pre-Display As with many forms in Avatar, before opening a form, Avatar will show you a pre-display. If you are filling out a client form, like an assessment, a pre-display will show you all episodes for the client. At other times, the pre-display will show may show you instances of this form being completed. For some forms, you will see a list of all instances when all staff have filled out the form. For other forms, you may only see all of the instances associated with a particular client. In the case of the Staff Messaging form, you will see only the times you have filled out the form. 54 P a g e

55 4) A blank Staff Messaging form will open up. a. Enter the Date and the Subject. b. In the Send Notification To field, click on the people to whom you wish to send the message. You may send a single message to multiple recipients. Note that recipients cannot see each other in the message. Essentially, when you send a message to multiple recipients, you are blind copying all of them. 55 P a g e

56 Required items: The labels for the Date, Subject and Send Notification To fields are in red font. In Avatar, red questions on forms are required. RED IS REQUIRED: When filling out Avatar forms, some questions are in red. These items are required. You will not be able to complete the form without completing these questions. 56 P a g e

57 5) In the Staff Messaging form, you also have the option of adding a specific client s name, the program to which the client was referred, and detailed comments. Once you have entered all of the information you want, click Submit to send. To Retrieve or Open a Message That Has Been Sent to You Open your messages in the My To Do s Widget. Unlike all other forms, you open a message by clicking, Review To Do Item. (For all other forms, you click on the name of the form.) STEPS: 1) Click Review To Do Item and the Review To Do Item portion of the form will open. 2) Click View Detail to see the content of the message. 57 P a g e

58 3) Read your message. When finished, click Dismiss in the lower right hand corner of the screen. You will be taken back to the Review To Do Item screen. 4) Click Reviewed to remove this item from your My To Do s and then click Submit. IMPORTANT: DO NOT CLICK REVIEW TO DO ITEM FOR ANY FORMS OTHER THAN MESSAGES. If do this, you will not open the form you need and you will start down a path do delete the link to the form in your My To Do s. For some forms, like group progress notes, there is no other way to open drafts. You cannot open a draft group progress note from the chart. 58 P a g e

59 Notification Users Form (If you don't have anyone to send messages to) If you are unable to send a Staff Message, it's possible that your list of other "Users" is blank. Use this form to add all users to your profile, so that you can send messages to everyone. Steps: 1) Search for, and open up the Notification Users form in your My Forms Widget in your Home Console. A window will appear called Avatar 2015 Workflow Notification Users. 2) Use the dropdown menu (the bar in the middle of the popup) and locate your name. Click OK. 59 P a g e

60 3) To Add all Avatar Users in Santa Cruz County Avatar, Click on Lists in the menu on the left hand upper corner of the screen to add users to your Staff Messaging. 4) Click on Add New Item. You should now see a green row appear in the Workflow Notification Lists table. 5) Then click Select List. 6) Select the list titled Everyone and click OK. When you click Submit, you will now be able to send a message to anyone using the Avatar system. YOU MAY NEED TO SIGN OFF AND SIGN BACK IN TO SEE USERS IN STAFF MESSAGING. 60 P a g e

61 Caseload Assignment: How to Have a Client Added to Your Caseload Once a client is added to your caseload, you will no longer get the Non-Caseload Access Warning. As of July, 2016, the Caseload Assignment form is not available for most users. If you need a client added or deleted from your caseload, send a staff message to Sylvia Vairo in Data Entry who will make the change for you. See instructions below. Include your Service Program in the message. 61 P a g e

62 Caseload Assignment Request Instructions If you need a client added or deleted from your caseload, send a staff message to Sylvia Vairo in Data Entry who will make the change for you. To Have a Client Added to Your Caseload To help us add a client to your caseload, we need the following information. Action to Take (Add/Remove): Add Clinician Name: Clinician User Number: Client Name: Client Number: Service Program (use exact wording*): Type of Assignment**: *Your Service Program or Program of Service is the team under which you typically bill services. When you do progress notes, this is what you enter in the "Service Program" blank. Examples: County Adult Recovery North, County Child Community Gate, County South FQHC Psychiatry, Encompass ADP Youth Svcs North-YES, Front Adult Willowbrook Residential. (Sorry to be so picky, but the form we use for this won t work without this info! ) ** Choose from the following: Primary Contact, Psychiatrist/Nurse Practitioner, Nurse, Trainee, Therapist, Substance Abuse, Housing Staff, Educational/Employment Staff, Peer Advocate, Benefit Representative, Field Responder, Other. If Other, please explain. To Have a Client Removed From Your Caseload To remove a client to your caseload, your message should have the following information only. We do not need the Service Program or Type of Assignment. Action to Take (Add/Remove): Remove Clinician Name: Clinician User Number: Client Name: Client Number: 62 P a g e

63 Understanding Client Admissions and Workflow Through the System Admission Programs and Service Programs Mental Health Programs Avatar has two types of programs, Admission Programs and Service Programs. An Admission Program is a broad admission that can cover many different types of services provided in an agency. Admission Program LE MH COUNTY OUTPATIENT Service Program County - Adult Recovery North Admission Program LE MH PARENTS CENTER OUTPATIENT Service Program Parent Ctr - Child Family Counseling An Episode is a single instance of an opening to an Admission Program. A client might be opened several times to the same Admission Program. For example, the client moves away, and then moves back. Each opening is an Episode. A Service Program is narrower than an Admission Program. Service provision (notes, billing) is completed under a Service Program (service teams, psychiatry, substance abuse treatment programs, etc ). Clients are not opened to Programs of Service (as with prior EMR systems). Once the Service Program County - North FQHC Services Psychiatry Service Program County - Child School Service Program County - North FQHC Therapy Services Etc... Service Program Parent Ctr - Child North Outpatient appropriate Admission Program is opened, service delivery commences. The appropriate Service Program is noted in the progress notes. Above, you can see two different Mental Health Admission Programs and their associated Service Programs. 63 P a g e

64 Substance Use Disorder (SUD) Programs This concept is slightly different in Substance Use Disorders (SUD) treatment vs. Mental Health (MH) treatment. In MH treatment, an Admission Program is a broad episode that encompasses the entire time a client receives services from an agency. It can go on for many years with many different types of services provided. In SUD treatment, due to different confidentiality regulations, the Admission Program is narrower and only specific to the particular treatment facility or program where the client is getting services. For each SUD Program, there are two mirror Admission Programs. Clients who do not wish to share their information with all Santa Cruz Avatar users are admitted to a sequestered program. Data in the sequestered program can only be seen by users who work in that program. In order for all Avatar users to view SUD program data, the client must sign the Consent for the Exchange of Confidential Mental Health and Substance Use Disorder Treatment Information. This permits all Santa Cruz Avatar users to share data and the client is admitted to the non-sequestered program. If a client changes their mind during treatment, data can be shifted from the sequestered to the non-sequestered program and viceversa. 64 P a g e

65 Client Registration & Financial Admission Program Client Registration & Financial is the first Admission Program for all clients in Avatar. No services are associated with this Admission Program. It exists to allow the client to be entered into the system and assignment of a client number only. Be careful to not add progress notes, assessments, etc under this Admission Program. If you do this, the data will have to be deleted and you will have to rewrite everything. In order to provide billable services, the client needs to be opened to another Admission Program (e.g. LE00044 MH COUNTY OUTPATIENT or County ADP Prevention HSA). County Pre Admit Outpatient Admission Program This unique Admission Program allows for limited service provision prior to the client receiving an Access Assessment and formally entering treatment. This allows for extended assessment periods for clients, as well as services for individuals who may never qualify for treatment, but require acute or crisis services. Some examples of the type of service allowed under County Pre Admit Outpatient: Field crisis for a non-open client Jail crisis or juvenile hall Crisis residential services Extended assessments for children under five Under this Admission Program, services may be provided for up to 60 days (or 90 days for children under 5). After 60 (or 90) days, the client must be discharged or admitted to another Service Program. 65 P a g e

66 Client Reg & Financial Client or representative calls or comes in for services, or a referral is received. Client opened to the Client Registration & Financial Episode or Admission Program. Client number assigned. Info noted in Service Request and Disposition Log. Assessment appointment scheduled. No services are billed. Pre-Admit Access Assessment Unclear if client qualifies for services and an extended assessment is done over multiple sessions. Client receives services, but no assessment is done. Client may not qualify. Examples: jail, crisis services, adult stepdown facility, extended assessment. Client closed after 60 or 90 days. Service provision (billable services) allowed. LE COUNTY OUTPATIENT Client has had an Access Assessment and had been determined to meet medical necessity criteria for services. Client referred in for services. e.g. psychiatry, therapy, case management. If client was previously opened to Pre-Admit, Pre- Admit is closed when LE County Outpatient is opened. 66 P a g e

67 Service Request and Disposition Log (SRADL) Santa Cruz Avatar If you are assigned a client that is new to services, there may be information in the SRADL Widget that will be helpful to you. In previous EMR systems, the Service Request and Disposition Log was called the Access Log or Call Logging. Services are initiated by either the client, or a representative (parent, guardian, hospital, contract agency). When the client or a representative contacts County Behavioral Health with a request for services, this must be noted in the Service Request and Disposition Log. This is a state requirement. There are clerical and clinical sections on the form. The person filling out the clerical section of the form files it in "draft" format. The clinician completing the form, re-opens the draft and then completes the clinical sections of the form. There is an associated widget, The Service Request and Disposition Log Widget where all entries in the SRADL are shown for a particular client. Clicking on an entry in the SRADL widget opens a single log entry for viewing or, if the entry has not been finalized, for editing. (Click on the blue date, which is where the link to the form is.) Search for the Client Admission Form To help you understand admissions, this tutorial shows you how to add a brand new client to Avatar, using the Admission form. If you are doing this as a training exercise, admit the client to Client Registration & Financial and then to your LE program. For example, if you work for County Mental Health, complete the Admission for Client Registration and Financial and then complete the Admission form for LE MH County Outpatient. If you work for and Encompass mental health program, open your client to Client Registration and Financial, and then LE Encompass Outpatient. 67 P a g e

68 (SUD Programs open to either the Sequestered on Open program, not to the LE. ) 1. Open the Admission form. Go to your Forms & Data Widget and search for the Admission form. Type admission" into the Search Forms field in the forms & Data Widget. Double click on the form when it appears on the list. Note that you want to select Admission. There are other forms with similar names that you do not want to choose. 68 P a g e

69 A Select Client Window will pop up. Before Avatar will open the Admission form for you, you will need to search for the client. This is because you want to see if the client is already in the system before admitting the client. 69 P a g e

70 2. Enter client data into the Select Client popup. Type in three pieces of information in order to search for the client. For example, Last Name, First Name and Date of Birth. Once three pieces of information are entered, the Search button will activate. (Even if you know you're adding a brandnew client, Avatar will want you to enter the information and perform the search. This helps ensure that this is not a duplicate client.) 3. Click Search. (If there are matches to your search, the names will appear and you can either double click on a name to select a client, or click on the name, then click the Select button.) If you are doing this as part of a training exercise, enter a brand-new client. Even if the name you have selected is already in Avatar, you will treat this as a new client. For training purposes, try to pick a unique name. 70 P a g e

71 4. If the client name is not in Avatar at all, a pop-up window will appear, letting you know that no matches have been found for your client. Click OK. The New Client button will activate. 71 P a g e

72 5. Click New Client on the Search Client window to launch the Admission form. 6. Avatar will ask if you want Auto Assign Next ID Number. Click Yes. Avatar will now open the Admission form. Complete the Admission Form 1. Admission Risk Assessment tab Once the Admission form is opened, fill in the open fields Identification and Treatment Information tab. Remember, items in red are required. You will not be able to submit (save and finalize) the form unless those items are answered. At the time of publication of this document, there are several questions on the Admission form that we will not be collecting. Below is a list and description of items that are needed for California State Data collection. a. Identification and Treatment Information b. Client Name will be auto populated from the Search Client window. 72 P a g e

73 c. Sex will be auto populated from the Search Client window if you used this parameter to search for the client. Otherwise, add this information in. "Other" = transgender, intersex, gender fluid, etc. "Unknown" = unknown gender. d. Date of Birth: Although not a required question, do your very best to gather this information. This will help identify the client and ensure the client is not entered into Avatar multiple times. e. Social Security Number: Although not a required question, do your very best to gather this information. This will help identify the client and ensure the client is not a duplicate. f. Program: First open the client to CLIENT REGISTRATION & FINANCIAL. CLIENT REGISTRATION & FINANCIAL Admission Program Client Registration & Financial is the first Admission Program for all clients in Avatar. No services are associated with this Admission Program. It exists to allow information to be entered into Avatar prior to the client coming in for services. It also allows a client number to be assigned. g. Type of Admission: Enter First Admission. h. Source Of Admission: Although not required by Avatar, this item is required for CSI data collection. Do your very best to answer this question if at all possible. i. Initial Point of Contact: If you are licensed/waivered/registered, enter your name. (If not licensed, see your supervisor for what name to enter.) Enter your ID here by typing in your last name and pressing Enter. Typically, this is the first clinical staff person encountering the client. j. Lead Provider: This is the person who will eventually be working with the client as the main contact person. Enter this information if you know who this person is. If you are practicing in avatar, add your own name. If you do not know who this person is, then leave the question blank. k. Skip the following: Practitioner Type, Disposition, Perform Discharge Alert, Type Of Alert. These items are not used. 73 P a g e

74 l. Presenting Problems/Disabilities tab: Only answer the Disabilities questions in this section. Skip the Presenting Problems questions and the Current Medications questions. m. Skip the remaining tabs and the Compliance Indicators section. Move on to the Demographics tab. 2. Demographics tab: Client race/ethnicity are required CSI items per Medi-Cal, although they are not red. Complete as many items as you can. 3. Inpatient/Partial/Day Treatment Tab: Skip this tab. None of these questions are currently used by Santa Cruz Avatar. Once you have completed your admission to Client Registration & Financial, you will complete a new admission to your unique Admission Program. Many of these Admission Programs begin with LE (Legal Entity). For example, for Adult or Children's Mental Health, the program is LE MH County Outpatient. 1. Select the Admission form from your Forms & Data Widget. 2. You will again see the Search Client window. Enter three data points for your client (e.g. last name, first name, sex). Then press search. Double-click on your client's name when it shows in the search window. (Alternately, click on the name of your client once to highlight and then launch the Admission form. Avatar will know that you want to do another admission for your client, enter client information will be pre-populated into the form.) 3. You will see a Pre-Display listing all of your client's prior admissions. Since this is a brand-new client, you will only see one admission listed, your prior admission to Client Registration & Financial. 4. In the Pre-Display, click Add in the lower left-hand corner. The Admission form will launch. 74 P a g e

75 5. Admit the client to your Admission Program or LE. For County Mental Health clients, this is LE MH County Outpatient. 6. Type of Admission will be First Admission since this is the first admission to your Admission Program. 75 P a g e

76 7. Complete the rest of the questions in the form, as previously described. 8. Open the chart of the client you just admitted. Do this by double clicking on the client name. In your client s chart, see the two admissions you just completed in the Client Episodes Widget. CSI Admission and Cal-OMS Admission 1. The CSI and Cal-OMS forms in Avatar are for inputting demographic data for Mental Health and Substance Abuse Treatment Services, respectively. 2. This information is entered when the client is initially opened to services, and then annually by the primary clinician. Staff providing direct service delivery, such as coordinators and therapists, complete annual updates. 3. If you are the person completing the Access or Intake Assessment, you may need to complete a CSI or Cal-OMS form. Unless a clerical person has already done this for you, you will need to do the form yourself. 4. Do your best to answer the questions on the form. GATHER AT LEAST: Last Name, First Name, DOB, SSN, gender. This way, we can insure that this is not a duplicated client. 76 P a g e

77 YOU DO NOT HAVE TO ANSWER: Questions about Problems and Medications. These are covered elsewhere in Avatar. CSI Widget This Widget is in the client chart and tells you if key information still needs to be collected. If the background of the Widget is yellow, there are items missing. The Widget background turns green when all of the information has been collected. Update Client Data form and CSI Information form These forms are used to update CSI Information. There are links to these forms in the CSI widget in the chart. CSI information is updated at least annually and when CSI information changes. This is done by the Lead Provider for the client using the Update Client Data form. Wait List Management When a program/unit has reached its capacity, clients may be added to the wait list using this form. This form also allows users to modify the order of clients as well as remove them from the wait list. Steps 1. In the Search Forms Field, enter Wait List, and select Wait List Management. 77 P a g e

78 2. In the program field, select the program. 3. In the Unit field, select the unit. 4. In the Client ID field, select a client already on the waiting list to edit, or use the search field to select a new client. 5. In the List Position field, select the client's priority in the waiting list. If more than one client exists on a list, you will see the list number. Depending on the criteria used (pregnancy, etc.) you may move the new client up or down the priority list, 1 being highest. When you choose any number on the list other than Bottom, you will see a dialog box asking if you wish the reorder the list. If that is true, select OK. 78 P a g e

79 6. In the Date Added field, enter the date this client was added to the waiting list. 7. In the Reason Added field, select the option that best describes why this client was placed on the waiting list. 8. In the Date Removed field, enter the date this client was removed from the waiting list. This can only be entered after the admission to the waiting list has been done. 79 P a g e

80 9. In the Reason Removed field, select the option that best describes why this client was taken off the waiting list. 10. In the Comment field, enter any additional information that may be useful. 11. The Comment History field displays previous comments for reference. 12. Radio Button Sub-section selections: choose all that apply. 13. Click Submit. 80 P a g e

81 14. To Add a Patient back to a Wait List, repeat steps 1-4 to retrieve client information. In the Date Added field, enter the date this client was added to the waiting list. 15. In the Reason Added field, select the option that best describes why this client was placed on the waiting list. 16. In the Date Removed field, remove the date this client was removed from the waiting list. It should appear as below, blank. 17. In the Reason Removed field, select F5, which should remove the selection and leave the Reason Removed blank. 18. In the Comment field, enter any additional information that may be useful. 81 P a g e

82 List Detail Section Overview This section provides detailed information about current and past clients on the waiting list. Steps 1. The List Details screen displays pertinent information related to clients on the waiting list. 2. In the List Properties field, check the Show Inactive box to display details on clients who have been removed from the waiting list. 3. Click Edit Removed Clients to edit details related to these clients. 82 P a g e

83 Wait List Management Report Overview Generate a report on waiting lists for a specific program/unit. Menu Path Avatar PM > Client Management > Census Management Reports Steps In the Program field, select the program. 1. In the Unit field, select the unit. 2. In the Date Added Start field, enter the first date that clients were added to this waiting list. 3. In the Date Added End field, enter the last date that clients were added to this waiting list. 4. In the Date Removed Start field, enter the first date that clients were removed from this waiting list. 5. In the Date Removed End field, enter the last date that clients were removed from this waiting list. 6. In the 'Position' field, limit the results by entering the first and last position numbers to generate in the report. 7. Select Submit, and Wait List Management Report will appear. 83 P a g e

84 Onset of Services form (Consents) How This Document Works This Avatar form, actually a set of several tabs related to several different types of consent forms, contains links to printable consent forms as well as areas for client electronic signatures using the signature pad. Even if a form is not signed using the signature pad, you can document whether or not the client has signed the paper form (which is then scanned into the chart). That way, users can easily see whether or not the client has signed these consents. The following consent forms (in both English and Spanish) are linked to this Avatar form: 1. Consent for the Exchange of Confidential Mental Health and Substance Use Disorder Treatment Information 2. Consent for Mental Health Treatment 84 P a g e

85 3. Consent for SUD Treatment 4. Notice of Privacy Practices (HIPPA form) Santa Cruz Avatar Note that releases for individual providers outside the Santa Cruz Avatar network are not linked in this form. This form should NOT be confused with the MHE 306 Authorization to Release Confidential Mental Health Information which permits information to be shared with entities/persons outside of Avatar such as Probation, Social Services, family members and others. (Pink county release form) There are sections for insurance authorization: 1. Medicare Payment Authorization 2. Private Insurance Authorization There is a section that documents whether or not the client was offered and/or provided the Guide to Medi-Cal Mental Health Services. Consent for the Exchange of Confidential Mental Health and Substance Use Disorder Treatment Information tab Please be advised that you should have the client/legal guardian sign this form at the earliest possible date. This form allows all providers inside Santa Cruz Avatar to legally share information about a client, including SUD providers. Even though the client has signed the Consent, anyone who is not involved with the person s care still needs to break the glass by filling in the Non-Caseload Access popup. Doing so creates an audit trail of anyone accessing the record. In order for SUD program data to be viewed by providers outside a particular SUD program, the client must completely fill out the form, checking off and authorizing all service providers listed. Otherwise, data from SUD programs is "sequestered." This means that any data relating to SUD programs is kept separate from other client information in the chart and can only be viewed by staff working in that particular program. If the client or representative declines to sign this form, the chart will be blocked. Blocking a record means only providers from that Admission Program would be able to view the record. This compromises any ability to collaborate with other providers and coordinate care. Steps: Printed form: If you do not already have a printed copy of the Consent for the Exchange of Information, print one out so that your client can sign it. There are links in the Avatar Consent to Exchange tab for both English and Spanish versions of the form. Make sure your client checks off all of the boxes on the form so that SUD records can be available to all Avatar users. 85 P a g e

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87 If the client declines to sign the form: If this is a mental health client, contact QA so that steps can be taken to sequester the client information if needed. If this is an SUD client inside an SUD program, the client will need to be admitted to the sequestered program. Once the client has signed the paper consent, fill out the first tab of the Avatar Onset of Services form. This tab has two subsections sections: A) ELECTRONIC HEALTH RECORDS B) CONSENT FOR EXCHANGE OF CONFIDENTIAL TO HEALTH AND SUBSTANCE USE DISORDER TREATMENT INFORMATION 87 P a g e

88 ELECTRONIC HEALTH RECORDS subsection Santa Cruz Avatar This section is at the top of the electronic form. Date and time are indicated here. The client signs electronically to indicate that they understand the purpose and use of electronic health records. 1. Have the client sign using the signature pad. 2. Fill in the Date and Time that the client signed the form. 3. Enter your name in the Staff Name field. CONSENT FOR EXCHANGE OF CONFIDENTIAL TO HEALTH AND SUBSTANCE USE DISORDER TREATMENT INFORMATION Subsection This section covers the Exchange of Information form. For this form, the client will sign a paper copy (link is in the electronic form) and the paper copy will be scanned in. The electronic form is a way to memorialize the client signing the form. This way, people can easily see that the client has signed the form when looking in the electronic chart. 1. Was the Consent for the Exchange of Confidential Mental Health and Substance Use Disorder Treatment Information scanned? The answer to this question, for the exchange form, will always be "Yes." This is because there are check boxes on the paper form for each entity in Avatar that must be checked off by the client in order to exchange information. These check boxes are not present in the Avatar Onset of Services form. 88 P a g e

89 2. If applicable, was the Consent for Exchange of Confidential Mental Health and Substance Use Disorder Treatment Information interpreted/translated into the client's preferred language? If the consent was interpreted for the client, click "Yes" for the interpretation question. Otherwise click, "N/A. If the client is Spanish speaking and is provided Spanish materials, click "N/A." 3. Client or representative's preferred language: Enter the preferred language if it is not English or Spanish. Otherwise, you can leave this question blank. If you click "N/A" in the prior question, this question will be disabled and you won't be able to answer it at all. 4. Notes on interpretation/translation of Consent for Exchange of Confidential Mental Health and Substance Use Disorder Treatment Information: In the this field, you may add any information about interpretation/translation. 5. This consent is being completed by: Enter role of the person who is authorizing or signing the document. 6. If not client, name of representative completing this form: Enter the name of the person authorizing the exchange of information if it is not the client. Otherwise, leave blank. 7. Relationship to client: If applicable, note the relationship of the person signing the form to the client. Otherwise, leave blank. 8. Client or representative refuses to sign Consent for Exchange of Confidential Mental Health and Substance Use Disorder Treatment Information: If the client or representative does not want to sign the form, click "Yes." Otherwise, click "N/A." 9. Client's or representative's reason for refusing to sign authorization for use, exchange, and/or disclosure of confidential information: If the client or representative refuses to sign the exchange form, you must note the reason why in the blank provided. (See instructions above for what to do if client refuses to sign form.) Consent for Mental Health Treatment tab For this form, the client may sign a paper copy, which is then scanned in, or the client can sign the electronic version. Links to the consent, in Spanish and English, are at the top of the page. 1. Was the consent interpreted/translated? If the consent was interpreted for the client, click "Yes" for the interpretation question. Otherwise click, "N/A. 2. What is the client or representative's preferred language? Enter the preferred language, if it is not English or Spanish. 3. Notes on interpretation/translation of consent: In the this field, you may add any information about interpretation/translation. 4. Was the consent printed, signed and scanned? If the client signed a paper copy of the consent (link to this document is at the top of the page) and then was scanned in, click "Yes." Depending on your workflow, your department may simply have the client read a copy of the form and then sign electronically using the signature pad. In this case, you would click "No" for this question. 89 P a g e

90 5. By signing below, the client or their representative acknowledges understanding the consent for MH services: Have the client sign the consent in the signature field. Click, Get Signature, to activate the field. If the client has signed a printed, paper copy, this field is disabled and you cannot use it. If the client refuses to sign, you will have the opportunity to note the reason later in the document. 6. Date (Client/Representative Signature): Note the date that the client or representative signed the Consent to Treat. Even if a paper copy was signed, note the date of signature here. 7. If not the client, name of representative completing this form: Note the name of the parent, Guardian or other representative consenting to mental health treatment for the client, if applicable. Otherwise leave blank. 8. Relationship to client: If applicable, note the relationship of the person signing the form to the client. Otherwise, leave blank. 9. Client or representative refuses to sign a consent services but agrees to treatment: Click "Yes" if the client/representative refuses to sign. Click "N/A" if the signature is obtained. 10. Client or representative reason for refusing to sign consent: If the client or representative refuses to sign the consent, you must indicate the reason why. 11. Copy of Consent: You must offer the client or representative a copy. Note whether they accepted. 12. Staff name: Enter the name of the staff person completing the document. Consent for SUD Services tab For this form, the client may sign a paper copy, which is then scanned in, or the client can sign the electronic version. Links to the consent, in Spanish and English, are at the top of the page. 1. Was the SUD consent printed, signed and scanned? If the client signed a paper copy of the consent (link to this document is at the bottom of the tab) and then was scanned in, click "Yes." Depending on your workflow, your department may simply have the client read a copy of the form and then sign electronically using the signature pad. In this case, you would click "No" for this question. 2. Was the SUD consent interpreted/translated? If the consent was interpreted for the client, click "Yes" for the interpretation question. Otherwise click, "N/A. 3. What is the client s preferred language? Enter the preferred language. 4. Notes on interpretation/translation of SUD consent: In the this field, you may add any information about interpretation/translation. 5. By signing below, the client acknowledges understanding the consent for Substance Use Disorder services: Have the client sign the consent. If the client refuses to sign, you will have the opportunity to note the reason in the next question. 6. Client refuses to sign consent for SUD treatment but agrees to treatment. Click "Yes" if the client/representative refuses to sign, but agrees to treatment. Click "No" if the client does not agree to treatment. 7. Date (Client Signature): Note the date that the client signed the Consent to Treat. 90 P a g e

91 8. Client reason for refusing to sign SUD consent: If the client refuses to sign the consent, indicate the reason why. 9. Copy of SUD Consent: You must offer the client a copy. Note whether they accepted. 10. Witness signature: Staff sign here. 11. Staff name: Enter the name of the staff person completing the document. 12. Date (Staff signature): Enter the date staff signed. Notice of Privacy Practices (HIPPA form) There are four links at the top of this form. The Notice of Privacy Practices (English and Spanish) documents provide information to the client about HIPPA and privacy. Provide a copy to the client in their preferred language. The Acknowledgment of Receipt of Notice of Privacy Practices (English and Spanish) are a separate page that the client signs and returns. 1. If applicable, was the Notice of Privacy practices interpreted/translated into the Client's preferred language: In the this field, you may add any information about interpretation/translation. 2. Date Notice of Privacy Practice GIVEN to client: Regardless of whether or not the client accepts a copy of the Notice of Privacy Practices, the client should be OFFERED a copy. Even if the client refuses the copy, add the date that you offered a copy to the client in this blank. 3. Client or a representative's preferred language: Enter the preferred language. 4. Notes on interpretation/translation of Notice of Privacy Practices: In the this field, you may add any information about interpretation/translation. 5. Notice of Privacy Practices Client/Representative Signature: Depending on your workflow, you may choose to have the client sign on the signature pad. Alternately, you may have the client sign a paper form and have it scanned into the chart. 6. Notice of Privacy Practices Staff Signature: Staff sign here. 7. If patient fails to, or refuses to sign acknowledgment, set forth the circumstances, and sign: If the client or representative refuses to sign, you must explain why here. Medicare Payment Authorization 1. Medicare Payment Authorization: Indicate whether or not the client authorized Medicare to be billed. 2. Medicare Payment Authorization Signature: Client signs to authorize Medicare billing. Private Insurance Authorization 1. Private Insurance Payment Authorization: Indicate whether or not the client authorized private insurance to be billed. 2. Private Insurance Payment Authorization [Signature blank]: Client signs to authorize billing private insurance. 91 P a g e

92 Guide to Medi-Cal Mental Health Services 1. Date Guide to Medi-Cal Mental Health Services offered to client: Enter the date client was offered a copy of the guide. The client does not have to accept the guide, you just need to offer it to the client. 2. If applicable, was the Guide to Medi-Cal Mental Health Services interpreted/translated into the client's preferred language? Indicate whether or not the guide was translated for the client. 3. Client or Representative's preferred language? Enter the client's preferred language if the guide was interpreted/translated. 4. Notes on interpretation/translation of Guide to Medi-Cal Mental Health Services: In the this field, you may add any information about interpretation/translation, if applicable. 5. Client or representative accepted copy of Guide to Medi-Cal Mental Health Services: Indicate whether or not the client accepted a copy. 6. Client's or representative's reason for refusing copy of Guide to Medi-Cal Mental Health Services: If the client refuses, enter the reason. Final/Draft Draft/Final Status: You must finalize this form before you can submit. Avatar Assessments: General Concepts 1. Assessments in Avatar are made up of multiple groupings of forms. To complete the assessment, you will need to complete several different forms. For example, the Psychosocial Assessment consists of the main Psychosocial Assessment form, plus the Diagnosis form, Risk Assessment, MSE, Drug Grid (Children s) and Diagnosis. 2. Some of these forms are required and some are completed only in certain circumstances. For example, only licensed/waivered/registered staff complete the Diagnosis form. In the diagram below, see how the Psychosocial Assessment and the Crisis Assessment have several associated forms in common. 92 P a g e

93 PSYCHOSOCIAL ASSESSMENT SHARED FORMS CRISIS ASSESSMENT Santa Cruz Avatar Psychosocial Assessment SC (main form) Risk Assessment SC: Required depending on certain questions about SI, HI, GD. DRUG Grid: required for some children, no adults. Required depending on answers to other trigger questions about substances. Diagnosis: staff role-based, only licensed, waivered, or registered clinicians Mental Status: staff rolebased, only licensed/waivered/registered clinicians Progress Note: required to document the service Risk Assessment Diagnosis MSE Progress Note (all forms are required) Crisis Assessment form (main form) Risk Assessment Diagnosis MSE Progress Note 3. Form Bundling a. For forms like the Psychosocial Assessment, it and some of its associated forms can be opened up automatically using bundling. b. Sequential vs Non-sequential Bundling: With sequential bundling, forms are opened up one at a time, in order, as they are completed. With non-sequential bundling, forms are opened up simultaneously and the clinician can choose which forms to complete first, or even move around between the various open forms until they are completed and finalized. c. Type in the word Bundle in the Search Forms field in your Forms & Data Widget on your Home Console to see the various bundles that are available. Note the various sequential and concurrent bundles available. Click on one of the Concurrent bundles to see all of the forms that are available. 93 P a g e

94 Psychosocial Assessment General Concepts 1. Tabs: The Psychosocial Assessment form is organized into tabs that address related types of information. For example, there are separate tabs for Mental Health History, Legal History and Trauma History. As you complete the form, you can click on the separate tabs to complete the information needed. It is recommended that you move through the form, one tab at a time, in order, because of certain question logic in the assessment. You may return to a tab to add information at any time. 2. Sections: Some tabs have many questions and are subdivided into sections. These are set apart with gray bars at the top of the section. You can click on the triangle at the left of each section divider to open up or collapse the section. 94 P a g e

95 3. Required Questions: In the Psychosocial Assessment, some questions are required and others are optional, although you are strongly encouraged to answer as many questions as possible, including those that are optional. Questions in red are required to finalize and submit the form. Some questions that are required by Medi-Cal are not red/required in Avatar. You must answer these questions to complete the form. 4. Lightbulbs: Throughout this and other documents, you will see a small light bulb symbol. If you hover over the symbol, you will see instructions on how to answer the question. 5. Question Logic: Some questions are required depending on the answers to other questions. For example, in the Legal History tab, the first question is required. Depending on the answer to the first question in the tab, subsequent questions are either required or disabled. In the example below, because the clinician clicked "No" to the first question about any legal involvement, all the other questions are not required and in fact are "grayed out" or disabled. No information can be entered into these questions. 95 P a g e

96 6. The Psychosocial assessment is unique in that it has a Backup Form button that will save the form while it is open. The button is on the left, just underneath the Submit button. EVEN THOUGH THE PSYCHOSOCIAL HAS THIS BACKUP BUTTON, YOU SHOULD STILL CLICK SUBMIT TO SAVE AND CLOSE WHEN YOU EXIT THE FORM. 7. When closing your assessment, DO NOT click the red and white "X". If you do this, the form will close without saving your data. Click SUBMIT to SAVE AND CLOSE. 8. Text Editor: If the text box requires a lengthy answer, you can pop out the text editor to see more of the field by clicking the associated icon. Click Save to close the popout and save your edits. If you do not click Save, your edits will not be saved. 9. Search Function: Click the tiny magnifying glass to search for a word or phrase in your text. 96 P a g e

97 10. Psychosocial Assessment Forms Checklist: Remember, in order to complete a psychosocial assessment, you will need to complete a combination of the forms below. Psychosocial Assessment SC: always required Risk Assessment SC: required depending on certain questions about SI, HI, GD. DRUG Grid: required for some children, no adults. Required depending on answers to other trigger questions about substances. Diagnosis: staff role-based - only licensed, waivered, or registered clinicians complete this Mental Status: staff role-based, only licensed/waivered/registered clinicians Progress Note: required to document the service Santa Cruz Psychosocial Assessment Form Open up a new Psychosocial Assessment SC form for your client. Open the chart and then click once on your client (in the My Clients Widget) to highlight in green, then double-click on the link to the form (found in My Forms). If the client is open to multiple admissions, you will see a pre-display with a list of those admissions. Select the most recent Admission Program under which you provide services, e.g. ME MH County Outpatient. The Psychosocial Assessment SC form will open. For training purposes, pick a client that has not had a prior assessment. See the section titled Assessment Updates for information on how to do an Update when there are previous assessments for the client. IMPORTANT: This form is episodic, that is, it is attached to an episode. Make sure you select your episode carefully. If you write the assessment under the wrong episode, it cannot be moved and you will have to write it all over again. 97 P a g e

98 Presenting Problem Tab 1. Date Fields: In the Presenting Problem section, enter the Assessment Date. Click "Today" or "Yesterday", or for a different date, type it in. Dates can be entered in Avatar by clicking the "T" or "Y" next to the date blank (today or yesterday). You can also type in the letter T annd press enter for today's date. You can use addition or subtraction to enter dates. For example, entering T-4 gives you a date from four days ago. IMPORTANT: Make sure you select the correct date. Once you save the form in draft, you will not be able to change this date. All other questions are editable if you close and reopen. 2. In the Type of Assessment field, select the appropriate type of assessment. 98 P a g e

99 3. In the Assessment for what population field, select the appropriate population. Question Logic for population: Note that there is a great deal of question logic associated with the population question, so make sure you click the correct box for this item. Various questions are required or disabled depending on the answer. If you change the answer to this question mid-way thought the assessment, some text boxes may clear and you will lose your data. 4. Draft/Final: Once you have answered the questions, Assessment Date, Type of Assessment and Assessment for What Population, skip to the very end of the assessment, to the last question at the bottom of the Summary Tab. Select Draft in the Draft/Final field radio button. At this point you have completed all the tasks necessary to save your document as a draft. You can submit the document and return to it at a later time. Now return to the Presenting Problem Tab. 99 P a g e

100 5. Complete the Presenting Problem (What made client/child come for services?) and Describe any functional Impairments fields. Culture/Spirituality Tab Complete data entry for the, Describe the client s/child s cultural practices and spiritual beliefs, question and the, Describe the client s/child s gender roles and sexuality, question. Mental Health Hx Tab Source(s) of clinical information field: This brief field is a chance to list the types of information you are using to complete the assessment. Examples: client report, hospital records, family. You only have about 20 characters in this field. If you need to discuss sources of information more thoroughly, use the larger narrative box in this section. The Mental Health History tab contains questions with radio buttons and checkboxes. Here are some helpful hints for working with these types of fields. 1. Use the arrow keys to move around in a checkbox field. 2. In list fields that contain multiple check boxes, you can use Ctrl + A to select all. To unselect all use Ctrl + D. 3. You can use the space bar to check or uncheck a box. 100 P a g e

101 4. Use F5 button to clear a question entirely, so that none of the radio buttons are checked. For Non-LPHA s: Where to put the MSE and Diagnosis Santa Cruz Avatar uses a separate form to enter the MSE and Diagnosis when doing an assessment. Licensed/waivered/registered staff or LPHA's should use the separate Mental Status SC form and the separate Diagnosis form to enter this information. If you are not an LPHA, you will not be able to use these forms. Only licensed/waivered/registered staff can use these forms. If you are not an LPHA, when you write your psychosocial, in the question, Mental Health History, (Mental Health History tab) note the most recent MSE along with the date of the MSE and the name of the practitioner who formulated it. Similarly, note the most recent Diagnosis, date and practitioner. Using example below, staff would note for diagnosis, Admission Diagnosis by Nancy Mast MFT of ICD-10 F20 Schizophrenia Paranoid Type on 4/1/2016. Write this in the text box for the question, "Mental Health History Licensed Waivered Registered Staff: 101 P a g e

102 You are required to complete the Mental Status form each time you complete a psychosocial. You are required to complete the Diagnosis form for an intake assessment, but for updates, only complete the diagnosis if it has changed. You must, however, at least review the diagnosis and make a note of this in the psychosocial. If the diagnosis has not changed since the last assessment, note in the Mental Health History question that you have reviewed the diagnosis and that it still applies. Risk Factors Tab The Risk Factors Tab contains question logic that turns various questions on and off. In addition, answering "yes" to certain questions launches another form, the Risk Assessment Form. If you answer Yes to either of the three questions about CURRENT DTS, DTO or GD, you must complete the Risk Assessment. Information about PAST DTS, DTO or GD does not trigger the Risk Assessment. You do not have to complete the Risk Assessment if DTS, DTO or GD is in the past, but not current. In the Risk Factors Tab, in the Violence Risk Section click "Yes" to the question, Current danger to others/homicidal ideation." A pop-up will direct you to open up the Risk Assessment. If this is an error or you want to come back to the Risk Assessment later, you may click No and return to the Psychosocial Assessment form. You will need to complete the Risk Assessment form at some point if answered Yes to any of the trigger questions. Grave Disability and Children: If your client is a child or youth, you will notice the question about GD is disabled or greyed out. This is because it is extremely rare for children, who have caretakers, to be legally considered GD. If you need to discuss GD, do so when you complete the Risk Assessment. Legal History Tab Note the embedded logic for current and past legal involvement. The first question about history of, or current legal involvement, activates or deactivates the rest of the questions in the section. 102 P a g e

103 Medical Information Tab Client Resources Form The question regarding primary care provider launches a window to the Client Resources form. The Client Resources form allows support people, family and other providers such as medical doctors to be entered into Avatar. If you don t have it, you can add the Client Resources form to your inquiry view to see this information (see the section titled, Add a Form that is Not Listed to Your Chart View. ) Pregnancy and Postpartum Sections: For Janus Perinatal Program only. Developmental History Tab Answer these questions as appropriate. These questions are required for children/youth. CRAFFT/CAGE AID Tab CRAAFT section (for children/youth) If the client is a child, the CRAAFT is enabled but not required. This is because it is required for children 12 and over only. The last question on the CRAAFT enables associated question logic. If two or more questions are answered Yes in the CRAAFT, then you will be prompted to complete the Drug Grid form. If you are required to complete the Drug Grid form, you will skip the Substance List Tab (next tab on the psychosocial), otherwise, you must complete the Substance List Tab, regardless of client age. (There is a single item that will allow you to enter "None for substances.) CAGE AID section (for adults) The CAGE AID is either required (adults) or disabled (children). 103 P a g e

104 Note that you do not complete the Drug Grid form for Adults. Instead, complete the Substance List Tab, which is the next tab on the psychosocial. If Client Declines to Answer CRAAFT and CAGE AID Questions Sometimes, a client will not be able to, or will refuse to answer the questions on the CRAAFT or CAGE AID. If this is the case, enter "No" for the questions that were not answered. Then, in the text box at the bottom of this section, explain that the client was not able to, or refused to answer these questions, and why. Substance List Tab Required for: 1. All Adults, and 2. Children for whom the Drug Grid was not completed. If a Drug Grid was completed for a child, then this tab is not required. Note that the label at the top of the tab is in red, but the questions here are not required and you will be able to finalize your assessment without answering the questions on the tab. 104 P a g e

105 The Substance List Tab contains a multi-iteration list. Information about each substance the client uses/abuses has its own line in the list. To add a substance to the list, you must first create a new line by clicking, Add New Item. The Substance List tab is for listing all substances used, not just those abused. For example, if the client drinks one cup of coffee per week, this should still be noted. Medi-Cal requires that we ask about the following: alcohol, caffeine, tobacco/nicotine, CAM (complementary and alternative medications), OTC drugs, and illicit substances and note any use information, even if the substance (e.g. caffeine, supplements) is used moderately and appropriately. If the client does not use a particular substance at all, you do not have to list it. Even if the client uses no substances at all, and the Substance List is required for your client, you must still complete the tab. If your client uses no substances at all, but you are required to complete the tab, proceed as if you are going to add a new substance (see below) but check, None for Substance Type. Everything else on the tab will then be disabled and greyed out, so you will not have to enter any more data on this tab. STEPS to Complete the Substance List Tab: 1. Click Add New Item: Begin by adding a new row to the table or multi-iteration list by clicking Add New Item to start a new row. (For each new substance, you will begin by adding a new row.) 105 P a g e

106 2. Fill out the rest of the row, entering information into the blanks below the table. Note that you will need to answer the questions for each substance in order, for the list to work properly. TO EDIT A ROW: In order to edit a row, you need to first select it. Double-click on the row that you want, or click once on the row, and then click Edit Selected Item. If you do not select the row, you will not be able to edit the information in it. TO DELETE A ROW: In order to delete a row, you need to first select it. Double-click on the row that you want to delete, or click once on the row, and then click Edit Selected Item. Then click Delete Selected Item. 106 P a g e

107 TIP: Make sure that you don't accidentally added an extra line in the table. It's easy to do by clicking on the button labeled, Add New Item too many times. If you accidentally add an extra row, you might overlook it because it is blank. Unfortunately, Avatar sees any blank lines that you leave in this table as unanswered required questions. You will not be able to submit your Psychosocial, either in Draft or Final, if you leave blank lines in this table. If you see this warning when you attempt to finalize your psychosocial, you know that you have blank lines in your Substance List. Substance Use Hx Tab Note the question logic based on the answer to the first question on the page. Trauma History Tab Does the client/child have a history of trauma? This question is required. Depending on the circumstances surrounding the assessment, your client may not be willing or able to answer questions about this topic. For example, for a psychotic individual who is currently hospitalized, this may not be the time for this discussion. Enter Unknown if you do not have sufficient information to answer the question. For assessments that take place over a number of sessions, you may be able to gather this information later and can add it to the assessment at that time. If you suspect, but do not have confirmation of abuse, you can discuss this in the text field below the question. Strengths Tab Describe client s/child s current or past strengths to achieve goals: This question is for documenting strengths specific to the client s anticipated ability to achieve treatment plan goals. Examples are resiliency, motivation, positive social supports. Describe what the client/child feels is important in their life: This question is appropriate for noting what motivates the client and other issues that are important to the client. It allows the clinician to enter items that may be personally motivating for the client, but that are not appropriate for the prior question such as: playing video games, smoking, hobbies. Work/School Tab: Answer questions as appropriate. 107 P a g e

108 Family/Social Tab: Answer questions as appropriate. Summary Tab Note that there are two Clinical Summary fields. Either one or the other is activated depending on your answer to the question, Is client being referred to/reauthorized for services? Both will not be activated at the same time on the form. IMPORTANT: If you write your summary, and then change your mind and click the other button, everything in your summary will be erased. 108 P a g e

109 Below, the client is recommended for services. Is client being referred to/reauthorized for services? has been answered with Yes. The clinician has written the summary in the first of the two text fields for the summary. 109 P a g e

110 If the question, Is client being referred to/reauthorized for services? is now clicked No, the entire text in the summary field is greyed out, and all of the information is lost. MAKE SURE THAT YOU DO NOT MAKE THIS MISTAKE. Clinical summary of recommended services: This field is activated if the client is authorized or reauthorized for services. This is where the justification for referral into services (or reauthorization for services) is entered. Although no diagnosis is entered in the psychosocial assessment, discussion of diagnostic formulation is appropriate for this field. Clinical Summary, explain reason for denial...this field is activated if the client is determined to not meet medical necessity and will be referred out. The reasons for this are documented here. Where is the diagnosis? Remember that assessments in Avatar are made up of multiple of forms. A Psychosocial Assessment consists of the main Psychosocial Assessment form, plus the Diagnosis form, Risk Assessment, MSE, and 110 P a g e

111 Drug Grid (Children s). Only licensed/waivered/registered staff complete the Diagnosis form (and the MSE). If you are not licensed/waivered/registered, review the diagnosis in the chart and then reference this in the Mental Health tab. See the section, For Non-LPHA s: Where to put the MSE and Diagnosis, for more information. Licensed Waivered Registered Staff: Once you complete your psychosocial, complete the Mental Status form. If required, complete a diagnosis. You are required to complete the Mental Status form each time you complete a psychosocial. You are required to complete the Diagnosis form for an intake assessment, but for updates, only complete the diagnosis if it has changed. You must, however, at least review the diagnosis and make a note of this in the psychosocial. If the diagnosis has not changed since the last assessment, note in the Mental Health History question that you have reviewed the diagnosis and that it still applies. How do I bill for the service? There is no place to enter service or billing information on the psychosocial. You will write a progress note documenting the service. See the section titled, Writing a progress note to document your service for an Assessment or Treatment Plan, for more information about how to write this note. Finalizing and Submitting the Psychosocial At the end of the Summary tab, Select Final. If you have missed one or more required fields, a window will pop up telling you which questions you still need to answer. There will also be red flags on the tabs for the sections that have the missing questions. If all required fields are answered, the Confirm dialog box will be presented. Select OK. The Draft watermark will be removed. Select Submit. The Confirm Document dialog box and TIFF (picture of the completed assessment) is displayed. As with the Progress Note form, you will have the opportunity to proofread. You may: 1. Accept the psychosocial as final and file it, 2. Reject the psychosocial so that you can return it to draft status and edit some more, 3. Accept and Route the psychosocial to a supervisor and/or approver(s). If you require a cosignature for your assessment, this notifies your supervisor who can then sign. Your supervisor may also need to complete a diagnosis and a MSE if you are not a licensed/waivered/registered practitioner. 111 P a g e

112 How to Reopen a Draft Psychosocial Assessment Form You may not be able to finish your psychosocial in one session. If you need to reopen your draft to continue editing, you can open up your draft from your Home Console or from the chart. Open a Draft Psychosocial Assessment from your Home Console 1. From your Home Console, type in the word "psychosocial" into the Forms Search blank in your Forms & Data widget. 2. Double-click on "Psychosocial Assessment SC. Do not click on the Psychosocial Assessment Report. This goes to a printout of the assessment that you do not want at this point. 112 P a g e

113 3. Enter your client name or number in the Select Client pop up and double-click on the client name. You will see a Pre-display of all of your client episodes. 4. Select your Admission Program from the pre-display. Either double-click on the Admission Program or click OK. 5. You will see a list of assessments that have been done under your Admission Program for this client. Double-click on your Draft Assessment to open it. 113 P a g e

114 6. You may get a warning that says that you have an unsubmitted backup of the form. You may get this if you have a previous draft of the form that you did not submit in the normal way. This is a complicated way of asking you whether or not you want to save and use the information that you previously entered into the form. Click "Yes." IF YOU CLICK NO, YOU WILL LOSE ANY UNSAVED DATA FROM THE LAST TIME YOU WERE IN THE FORM. Open a Draft Psychosocial Assessment from the Chart 1. Open the chart and click on the link on the left, Psychosocial Assessment SC. 2. Click on the tab associated with your Admission Program. 3. Click on the word "Edit" at the upper right. (It is in the border next to the word "Print.") 114 P a g e

115 How to View a Completed Psychosocial Assessment in the Chart 1. Open the chart and click on the link on the left, Psychosocial Assessment SC. 2. Click on the tab associated with your Admission Program. 3. View the psychosocial assessments for your program. Note that both drafts and final forms are available for viewing. 115 P a g e

116 How to Print a Psychosocial Assessment Form You can print a paper copy of your Psychosocial from the Inquiry View in the chart or from a specially formatted report. Note that the report contains every question in the psychosocial. You may, depending on your needs, want to just print what you see in the Inquiry View in the chart, which only contains the questions that have data in them. Print a Copy of your Psychosocial Assessment from your Home Console: 1. From your Home Console, type in the word "psychosocial" into the Forms Search blank in your Forms & Data widget. 2. Click on "Psychosocial Assessment Report." 3. In the appropriate blanks, enter the Episode and then choose the assessment that you want to print. 4. Click "Process." (Located where you usually find the "Submit" button.) A formatted copy of your assessment will open. 5. To print, click the little printer icon at upper left. 116 P a g e

117 Psychosocial Assessment Updates If your client has had a previous Psychosocial Assessment under your Admission Program, information from the prior assessment will be auto populated into your current assessment automatically when you open a new one. You may then edit the document, updating the previous information. If the client has had more than one Psychosocial Assessment under your Admission Program, Avatar will present a list of all of the client s prior Assessments in your Admission Program. You may then select which prior assessment to use to populate your new assessment. Note that this only works within one Admission Program. For example, if there is a psychosocial done under County Pre Admit, you will not be able to automatically add information into an assessment under LE MH COUNTY OUTPATIENT. To select an assessment from which to auto populate your new assessment 1. Select the Psychosocial Assessment SC form in your Forms & Data Widget. 2. You will see a window listing all of the open episodes for the client. Select the episode associated with the services you provide. 3. You will then see Pre-Display listing all of the prior assessments for your client. Click once on the assessment you want to use to highlight it in green. 4. Then click Add, in the lower left hand corner of the window. When to complete the form: Risk Assessment Form When completing the Psychosocial Assessment, The Risk Assessment is completed when questions about current danger to self/suicidality, danger to others/homicidality, and grave disability are answered Yes. The Risk Assessment is always required when completing a Crisis Assessment. The Risk Assessment may also be used in other instances. For example, ongoing assessment of a therapy client with frequent suicidal ideation. Consult with your supervisor if you think using this form might be helpful in your clinical work. Make sure you ask clients about access to weapons such as firearms when discussing a plan to harm themselves or others. Discuss in the Comments section(s) of the form. 117 P a g e

118 Mental Status Exam (MSE) Form When to complete the form: The MSE is always required when completing the Crisis Assessment. It is also required for the Psychosocial Assessment if you are licensed/waivered/registered (LPHA). The MSE may also be used in other instances. For example, ongoing assessment of a therapy client, so that changes in status and presentation can be compared from session to session. This form consists primarily of check boxes. Note that text fields at the end of sections are optional. Supplementary questions in the Questions Tab are also optional. CANS/ANSA Form The Child Assessment of Needs and Strengths (CANS) and the Adult Needs and Strengths Assessment (ANSA) are combined in one form in Santa Cruz County Avatar. This multi-purpose tool has been developed for behavioral health services to support decision making, including level of care and service planning, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services. The form also helps to facilitate the linkage between the assessment process and the design of individualized service plans including the application of evidence-based practices. When to complete the form: The CANS/ANSA form in Avatar is completed in conjunction with the Access Assessment and then every six months after that. A paper version of the form is available for field use. Once you return to the office, enter the data into the Avatar form. Question Logic: This form has many items that have question logic. It is important that you complete all of the questions in this form in order because of question logic. The way you answer earlier questions, affects how other questions downstream act. The way you answer one question, may affect whether or not other questions are red/required, enabled or disabled (greyed out). In order to complete the form, required (red) questions must be answered. You cannot finalize and submit the form unless you answer all required questions. Disabled questions appear with a grey background and you cannot enter data into them. Monolingual Spanish Speaking Clients: Currently, there is no Spanish form in Avatar. If your client speaks Spanish, use the pre-avatar paper form. You should fill out this form and then turn it in to data entry. Steps to filling out the form: 118 P a g e

119 1. Open the form either from the Inquiry View in the client s chart, or from the Search Forms blank in your Forms & Data Widget. 2. Complete Overview Tab: The first tab on the form is the Overview. The Overview tab has questions about basic client information relevant to the rest of the questions on the form. As in any other form, required items appear in red, optional items appear in black and disabled items appear in gray. On the Overview tab, fill in the Assessment Date, which is the date you complete this assessment. 3. Assessment Type: The first assessment for your client will be an "Admission. For subsequent updates, click "Update." Ask your supervisor if doing a Discharge CANS/ANSA is part of your workflow. If so, and you are completing the CANS/ANSA as part of the discharge, click "Discharge." 4. Age Group: Click the appropriate age group for your client. Three separate age groups have been integrated into one form in Avatar (0-5, 6-17, and 18+). When you select the age group, the form activates questions throughout the form that apply only to that specific age group. All other items are disabled or greyed out. IMPORTANT: Make sure that you click the correct age group. If enter the wrong age group and then correct the mistake later, you will lose data that you have already entered in the form. 119 P a g e

120 Shown below, the question, "Client Current Age Group," is entered as 0-5 some questions on the next tab, Strengths Domain, are red/required, and other questions are grayed out or disabled. 120 P a g e

121 If the question, "Client Current Age Group," is entered as 18 and over, different questions on the Strengths Domain tab, are red/required, and different questions are grayed out or disabled. 121 P a g e

122 5. Caregiver's Relationship to Client: Answer this question for both children and adults. For adults, if there is not a primary caregiver, enter "N/A." If none of the selections in this question apply, click "Other, then enter the type of relationship in the question below ("If Other, Enter Type of Relationship Here"). 6. Caregiver Name: If you have entered any response other than, "N/A to the Caregiver Relationship question, you will need to enter the name of the caregiver here. If the caregiver is associated with an agency, you may enter the information. For example, Jane Smith/IHSS. 7. Draft/Final: Note that this question is on the first tab rather than at the end of the form as in other Avatar documents. When you complete the form, you may find yourself looking for this question on the last tab. Remember that it is here. 8. Complete the remaining questions on the form in order. It is important that you complete all of the questions in order because there is significant question logic in this form. That is, the way you answer some questions, will affect how other questions appear. The modules of the CANS/ANSA are integrated into the body of the form. If a trigger question for a module is scored 1, 2 or 3, the items of the module will be activated, and the required items will be highlighted in red. For example, the item, "Intellectual/Developmental (IQ)" affects how questions appear in the, "INTELLECTUAL/DEVELOPMENTAL MODULE" below it. If the, "Intellectual/Developmental (IQ)" item is entered as a "3," then the questions in the associated module below are all enabled/required. 122 P a g e

123 If the, "Intellectual/Developmental (IQ)" item is entered as a "0, then the questions in the associated module below it are disabled/grayed out. To Print a Copy of Your CANS/ANSA There is a report for the CANS/ANSA that can be opened from the chart or from the Home Console. Use this to print a formatted copy of your completed CANS/ANSA to give to the client. 1. Search for the form, CANS ANSA Assessment Report, from the client chart or the Home Console. 2. Click on the name of the form to open it. 3. If you have pre-selected the client, the client s name will appear in the PATID blank. Otherwise, enter the client ID. 4. From the List of Client Assessments dropdown, select the form you want to print. Forms are listed by date only, so make sure you know the date of the CANS/ANSA you want to print. 5. Click Process to generate a report for the form. Note that the report may take several minutes to generate. 6. If the report doesn t pop up, click on the large Avatar symbol at the bottom of your Windows desktop to view it. 7. To print, click on the little picture of the printer in the upper left-hand corner of the report screen. 123 P a g e

124 ASAM Form The American Society of Addiction Medicine Criteria (ASAM Criteria) assesses the client for placement and facilitates creation of substance abuse treatment plans. It is used primarily by ADP treatment programs. If clients have consented to share their SUD records, the ASAM results will be viewable in Avatar. The ASAM assesses five broad levels of treatment. These levels are medical management, the level of structure, safety, security and intensity of treatment. ASAM criteria addresses the client s needs, obstacles and liabilities, as well as the client s strengths, assets, resources and support structure. ASI Form 124 P a g e

125 The Addiction Severity Index (ASI) is a semi-structured interview for substance abuse assessment and treatment planning. The ASI is designed to gather valuable information about areas of a client s life that may contribute to their substance-abuse problems. It is the most commonly used addiction assessment tool by state agencies and treatment providers and is performed at intake. A completed ASI calculates a severity rating scale allows the interviewer to determine the seriousness of a client s problem. The higher the score is, the greater the need for treatment. Admission Diagnosis When to complete the Diagnosis form Every episode requires a diagnosis. Without a diagnosis, no services can be billed. The date and time of the Admission Diagnosis must be on or before the date and time of first billed services. For example, a client is admitted on September 2nd at 10:00 AM and seen for services on that day. If the diagnosis is date is entered as September 6th, all services between September 2nd and the 6th will not bill. So the diagnosis date should be September 2nd. The time should be before 10:00 AM. Unless your program has a special need to note the exact time of diagnosis, the easiest way to make sure you are covered with regard to the time, is to enter the diagnosis time as 12:00 am. (TIP: Type 0000 and press enter.) The Diagnosis form in Avatar must be completed in conjunction with the Access Assessment. In addition, each admission must have its own diagnosis. If your client already has an Avatar diagnosis for your episode, it is not necessary to complete a new diagnosis when the annual assessment is due. If the diagnosis has not changed, it is sufficient to let the admission diagnosis stand. (Note this in the Mental Health History question in the Psychosocial.) The diagnosis may be updated at the time of the annual assessment or at any time. See the next section for more information. 125 P a g e

126 Check the chart to see if there is an existing diagnosis before proceeding with service delivery. Each episode must have its own diagnosis. You may open a diagnosis from the client s chart, or from the Home Console. Below are directions on how to open a new diagnosis form from the chart. When completing an update, you will first want to look in the chart for prior diagnoses. To View a Client s Current Diagnosis 1. Open the client s chart. 2. Select the Diagnosis form in the list of forms on the left to open the Inquiry View. (If you do not see the Diagnosis form, you may need to add it to the chart. See the section titled, Add a Form that is Not Listed to Your Chart View. ) 3. You will see series of tabs across the top of the inquiry view that shows all of the client episodes. Click the tab that corresponds to the Admission Program or episode under which you provide services. For County Mental Health clients, the Admission Program is LE MH COUNTY OUTPATIENT, or possibly, County Pre Admit Outpatient. You can now view the current diagnoses to see if you want to update or not. Below are instructions on how to add a diagnosis for a client that does not have a previous diagnosis. (See the next section for how to do a diagnosis update.) STEPS: 1. Open the chart for your client and then click the Diagnosis link on the left. 2. Click the tab for your Admission Program. 3. Verify that the client does not have a diagnosis for your current open episode for your Admission Program. If there is already a diagnosis, review the diagnosis. You may choose to add to it at this point. See the next section for instructions. 4. Click, Add in the upper right hand corner of the chart view. A blank Diagnosis Form will open. 5. Diagnosis Type = Admission 6. Enter Date of Diagnosis. Since this is an admission diagnosis, the date of diagnosis will be the opening date for the episode. The date of diagnosis is automatically populated as the admission date for an admission diagnosis. 7. Enter 12:00 AM for the time of diagnosis. (For most programs, it is fine to enter the diagnosis time as 12:00 AM. Check with your supervisor if you think you might need to enter the time exactly.) (Tip: If you type 0000 the time will automatically enter as 12:00 AM.) 126 P a g e

127 If you are creating the first diagnosis for your episode, YOU MUST CLICK ADMISSION FOR THE DIAGNOSIS TYPE. If you click Update, Discharge or Onset, you won t be able to bill for services. 8. Begin entering your diagnosis by adding a new row to the Diagnosis table. Click the "New Row" button underneath the table. In this form, you do not add information directly to the table. There are fields below the table where you enter your diagnosis information. 9. Type in a diagnosis in the Diagnosis Search field, then click Enter on your keyboard. 127 P a g e

128 IMPORTANT: Take your time typing your diagnosis and then pause for a second after you press Enter on your keyboard. Avatar is searching a web-based data base of more than 15,000 diagnoses and this takes a bit of time. Double-click on the most appropriate diagnosis entry. To narrow down your diagnosis and get a smaller list from which to choose, type in as accurate a diagnosis as you can. For example, type "major depression" rather than just "depression" to narrow down your selections. 10. Enter the Status Field. The Status field defaults to Active. Note that the primary diagnosis must be Active. In addition, any diagnosis for which you are providing services must be Active. If a diagnosis becomes resolved, you can return to the diagnosis form to resolve it. 11. Enter Estimated Onset Date. Although this question is not required here, it is required for the treatment plan, so you will want to enter this information. Typically, it is very difficult to identify an exact date of onset for a psychiatric diagnosis, so use the following convention: Enter Jan. 1 for the month and date. Enter the closest approximate year. e.g. 01/01/1990. ONSET DATE IS NOT THE OPENING DATE FOR THE EPISODE. 12. Enter Present on Admission Indicator, if applicable. 13. DO NOT ENTER Classification. THIS NO LONGER APPLIES. 128 P a g e

129 14. Enter the required Diagnosing Practitioner (this is you), the Ranking, and any appropriate Remarks. The Bill Order will default to 1. The bill order determines which diagnoses are attached to services first. For Mental Health services, make sure that the first diagnosis is an included mental health diagnosis. For example, schizophrenia, bipolar illness, depression. For subsequent diagnoses, the bill order should default to 2 or 3. If not, you should type in the Bill Order in the Bill Order blank. Note that Avatar wants the bill order and the ranking to match. If they don t, you will not be able to complete the form. The Diagnosis multi-iteration table will now look like this: 129 P a g e

130 15. Add To Problem List: Enter Yes. By clicking Yes you add this diagnosis to the problem list (also called the Problems Table) that is used in creating the treatment plan. (It populates the Problems Table in the Treatment Plan.) Typically, you will click Yes when answering this question. 16. Skip the Additional Diagnosis Information section. This section is not used in Santa Cruz Avatar. 17. Click Submit. Diagnosis Update When to complete an Update: Complete a Diagnosis Update when there is already a diagnosis your current episode and the diagnosis has changed. Once the diagnosis is completed for a client (for an admission program) it is not necessary to complete a new one when the annual assessment is due. But if the diagnosis has changed, it may be updated at the time of the annual assessment or at any time. Complete an update when the client s diagnosis has changed. For training purposes, pick a client that has a previous diagnosis. The previous section describes how to complete an initial diagnosis. You may open a diagnosis from the client s chart, or from the Home Console. Below are directions on how to open a new diagnosis form from the chart. When completing an update, you will first want to look in the chart for prior diagnoses. 130 P a g e

131 TO VIEW CLIENT S CURRENT DIAGNOSIS: Santa Cruz Avatar Before completing a Diagnosis, you always want to check the chart to see what Diagnoses are there. 1. Open the client s chart. 2. Select the Diagnosis form in the list of forms on the left to open the Inquiry View. (If you do not see the Diagnosis form, you may need to add it to the chart. See the section titled, Add a Form that is Not Listed to Your Inquiry View. ) 3. You will see series of tabs across the top of the inquiry view that shows all of the client episodes. Click the tab that corresponds to the Admission Program or episode under which you provide services. For County Mental Health clients, the Admission Program is LE MH COUNTY OUTPATIENT. You can now view the current diagnoses to see if you want to update or not. STEPS TO UPDATE THE DIAGNOSIS: 1. In the chart, in the far upper right hand corner, click on Add to create a new diagnosis. A blank Diagnosis Form will open. 2. Type of Diagnosis = Update 3. Enter the Date of Diagnosis and the Time Of Diagnosis 131 P a g e

132 4. Select Episode To Default Diagnosis Information From: You may select Your Admission Program or any other program that has a diagnosis. If there is a prior diagnosis under your own admission program, you want to use that. If you don t have a diagnosis to choose from, you MAY use a diagnosis from a different program. Alternately, if you are licensed/waivered/registered, you can add your own diagnosis, based on your clinical findings from interviewing/assessing the client. See your supervisor if you are unsure what to do. 5. Once you select your default diagnosis, you will get a popup warning you, All unsaved data will be lost. Do you want to continue? Click, Yes. 132 P a g e

133 6. Select Diagnosis Entry To Default Information From: Typically, you will select the most recent diagnosis. The diagnoses in the list are labelled with the date and time they were entered. The previous diagnosis you have selected will be populated into the Diagnosis table. You may now add additional diagnoses or resolve one or more of the previous diagnoses. 7. To add a diagnosis, click, New Row, and follow the instructions from the previous section for adding diagnoses. To Resolve a Diagnosis You cannot edit a completed (submitted) diagnosis form. If you wish to resolve a prior diagnosis, you must first open up a blank diagnosis form and add in the prior diagnoses you wish to resolve. See above for steps. Once you have added the diagnoses you wish to resolve, follow the steps below. 133 P a g e

134 1. First, click on the diagnosis you wish to resolve so that it is highlighted in yellow. When you do this, this fields below the diagnosis table will be auto-populated with information from the selected diagnosis. 2. In the Status field, click Resolved. 3. Enter today s date in the Resolved Date field. 4. You will need to remove the Ranking and Bill Order so that the resolved diagnosis no longer bills. You want billing associated with your new diagnosis. a. To Remove the Ranking, click on any of the radio buttons in this question, then click F5, which will clear the field. (TIP: This works on any field in Avatar that has boxes, buttons or drop down list items.) If you have done this right, none of the radio buttons in this field will be clicked. b. Change the Bill Order number. This question 134 P a g e

135 is required and thus must have data in it. Enter a high number such as Once you have resolved the diagnosis/diagnoses you don t want, add the new diagnosis/diagnoses as shown previously and then click Submit. 135 P a g e

136 Scheduling Calendar The Scheduling Calendar is different than the Calendar Widget. In the Scheduling Calendar, appointments are managed. Scheduling, moving, cancelling and deleting appointments happens here, just like in any other electronic calendar. Progress notes can be launched from the calendar. In contrast, The Calendar Widget only allows you to perform a few functions like launching progress notes. When to use your calendar: Most County Mental Health staff are required to use the calendar for all services provided. Talk to your supervisor about whether or not you should use the Scheduling Calendar. Scheduling an Appointment in the Scheduling Calendar Use this tutorial to practice scheduling an appointment in your calendar. 1. Open the Scheduling Calendar: Use the Forms Search to search for Scheduling Calendar. (HINT: Spelling counts! If you type in the word, "Schedule," Avatar will not pull up the form.) If you get a warning that says that your username is not set up to see other practitioner calendars, this probably means that your supervisor has not yet set up your calendar. If your calendar is not set up, you will not be able to open your calendar at all. Let your supervisor know that they need to set up your hours in your calendar so you can use it. 136 P a g e

137 2. Once you open your calendar, you should see your name at upper right. Make sure the little checkbox next to your name is checked or you won't be able to see your appointments. 3. Click on the Day, Week or Month view: The default view shows you one day, today. Click on the Week view to see a week s worth of appointments. Click on Month to see a whole month s worth of appointments. You may see a list of several clinicians to the right of the calendar. If this is the case, click your name from the Clinician list on the left side of the Scheduling Calendar. Site: A Site can be a workgroup or a location. If you don t see your name, you may not be viewing the correct Site. Click on your assigned site to find your name. Team: Santa Cruz Avatar does not use the Team designation. Leave the question titled "Team" as "No Team Selected." 137 P a g e

138 4. Right Click on the calendar at the desired appointment time and then click Add Appointment. (Don't worry too much about getting the appointment into the exact right spot. After you schedule the appointment, you can easily adjusted by moving the appointment around with your mouse.) 138 P a g e

139 5. The Add New Appointment form will open, with the APPOINTMENT, section pre-filled. You will see your name in the Practitioner field. The Appointment Site, Appointment Date, Start Time, Duration, End Time and Appointment Status are all also autofilled. If you wish to change the appointment time or duration, you may do so at this point. If you change the duration for the appointment, the End Time will automatically recalculate. 139 P a g e

140 6. Program: This is the Service Program under which you provide services, e.g. County Adult Recovery, Encompass Child Enhanced Sup Svcs, County Child School. (The Admission Program is noted in the Episode field.) 7. Location Code: For most programs, the Location code will auto-populate to Office. Change if needed. 8. Service Code: Select the Service Code. Note that you must first select the Program before the Service Code. This is because Avatar won t know what Service Codes are available without knowing the Service Program. (E.g. only psychiatry can provide medication services.) 9. Select the Client and Episode. You must do this in order. Avatar won t know what Episodes you have to pick from if you don t select the client first. 10. Enter CO-PRACTITIONER(S) if applicable. 11. Enter RECURRING APPOINTMENT Fields as needed. a. Enter Once for a one time appointment. b. Recurring appointments: i. Enter Weekly for a weekly appointment. ii. The Recurrence End By field will open up. iii. Selecting End After allows you to elect to end the series after a certain number of sessions. Enter the number of sessions in the blank. iv. To schedule an appointment every other week, enter Other under Recurrence Schedule and then 14 in the blank for Days. v. Selecting No End schedules the recurring appointments for a year. Note that appointments don t actually get scheduled into infinity. If your recurring group or appointment goes on for more than a year, you will need to go back into your calendar and set up the appointment series again, after a year has gone by. 140 P a g e

141 12. Click Submit to enter your single appointment or series in your calendar. Notice the circular arrow in the upper right hand corner of each series appointment. Appointments that are not part of a series do not have this circular arrow. Santa Cruz Avatar If you have scheduled a series, you can go back and delete all or part of a series at a later time. To Delete Multiple Appointments in a Series An example of when you might do this is if you have scheduled a series as having no end date, but now you want to end the series. In your Scheduling Calendar, find one of the appointments in the series. Right click on the appointment. Select Delete. A list of all appointments in the series will pop up. You can then select which ones you want to delete. (HINT: If you want to delete all or most of the remaining appointments in the series, press CRTL + A on your keyboard to select all appointments in the series. You can then uncheck any appointments you want to keep.) To Adjust One Appointment in a Series You can change the time of an appointment in a series without changing any of the other appointments in the series. First, right click on the appointment and click Details/Edit. You will get a popup asking of you want to edit this occurrence or the series. Click, Current Occurrence. At this point, you can adjust the time or the Appointment Status. Note that you won t be able to change the appointment date. To change the date of one appointment in a series, you must delete the appointment by changing the status to Cancelled, and then reenter the appointment as a single appointment on a different day. 141 P a g e

142 13. Once your appointment has been entered, one of the options is to right click to enter progress notes for the appointment, such as SC General Purpose Progress or SC Med Service Progress Note. When you open a progress note from an existing appointment, all of the information from the appointment is already added to the note, so you do not have to enter it again. 14. You can adjust the appointment time and date, or even the length of the appointment by clicking and dragging. If you have access to multiple calendars (e.g. reception or supervisors), you can even move appointments from one person s calendar to another, by clicking and dragging the appointment. 15. When you are finished with the calendar, click on Dismiss and the bottom of the form. 142 P a g e

143 Scheduling Calendar vs. the My Calendar Widget Santa Cruz Avatar The Scheduling calendar is used to create appointments, find open appointments and view multiple schedules for a workgroup such as psychiatry staff or a service team. The My Calendar Widget allows viewing existing Client appointments. Right clicking on individual appointments in both the Scheduling Calendar and the My Calendar Widget will launch the Individual Progress Note form, but not the Group Progress Note form. See the Group Progress Notes module for more information. Finding an Existing Appointment in the Scheduling Calendar Unless you are a supervisor or in certain clerical roles, you will not have access to other staff members calendars. Even if you cannot view other people s calendars, you can still check to see if a specific client has an upcoming appointment, or look for open appointments. You do this using a link in your Scheduling Calendar to open a special form for this purpose. Steps 1. Open your Scheduling Calendar. 2. In the lower right-hand corner, look for the link to the Find Existing Appointments form. (Below the Today button.) 3. Once the form opens, you will see many questions designed to narrow down your search. a. Search Sites: this narrows down your search by site. For example, if you are looking for psychiatry appointment for North County Adults, click No. Co. Adult Psychiatry. b. Note that the button to submit the form is in the middle of the form and that the Submit button on the left of the form is grayed out and disabled. 4. To find a scheduled appointment for a specific client, enter the client's name in the Client field. 5. To find an open psychiatry Intake or Same Day/Next Day, appointment, search for the client RESERVED TIME. Appointments in Avatar must be scheduled with a client. RESERVED TIME is a "placeholder" client used to set aside Intake and Same Day/Next Day psychiatry appointments in the calendar. Below, the Find Existing Appointments form is filled out to search for the RESERVED TIME client. 143 P a g e

144 6. Below you can see the next 10 open appointments for Medication Management. They have all been scheduled with the client RESERVED TIME. Click Cancel at the bottom of the appointment list to close. 144 P a g e

145 Finding a New Appointment in the Scheduling Calendar Use the link to the form, Find New Appointment to look for blank, open spots in a single calendar or for an entire site, such as 1-No. Co. Adult Psychiatry. Staff Daily Schedule: Print Out Your Appointments for One Day At the beginning of the workday, you can create a printout of your appointments for the day, using the form Staff Daily Schedule. (For one week of appointments, use Staff Weekly Schedule.) NOTE: This printout only contains appointments where you have not completed a linked progress note. If you have seen the client an then written the progress note from your calendar, the appointment will not show up on this report. 1. Open Staff Daily Schedule from your Forms & Data Widget. 145 P a g e

146 2. Enter your Site, for example, 1-No.Co. Adult Psychiatry, or No. Co. Adults. If you do not know what your site is, open your Scheduling Calendar and see your site in the upper left corner of the calendar. 3. Individual Or All Practitioners: Select Individual 4. Practitioner: Type your last name and click on yourself. 5. Click T for Start Date and End Date 6. Display Cancelled Appointments: Click N (Clicking Y does not display cancelled appointments.) 7. Click Process to view your schedule. 8. To enlarge the view, click where it says 100% to pull up a menu. 9. To Print, click Print at lower right and use the popup to direct to the printer you want to use. 10. Click the red and white X to exit. 146 P a g e

147 Staff Weekly Schedule: Print Out Your Appointments for One Week To create a printout of your appointments for the week, use the form Staff Weekly Schedule. 1. Open Staff Weekly Schedule from your Forms & Data Widget. 2. Enter your Site, for example, 1-No.Co. Adult Psychiatry, or No. Co. Adults. If you do not know what your site is, open your Scheduling Calendar and see your site in the upper left corner of the calendar. 3. Individual Or All Practitioners: Select Individual 4. Practitioner: Type your last name and click on yourself. 5. Week Of: Enter any date in the week you want to print. Avatar will give you a Monday Friday schedule. 6. Display Cancelled Appointments: Click N (Clicking Y does not display cancelled appointments.) 7. Click Process to view your schedule. 147 P a g e

148 8. To flip through the pages of the schedule, click the page number (bottom left) or click the Next > > and < < Prev buttons. 9. To enlarge or shrink the view, click where it says 100% to pull up a menu. 10. To Print, click Print at lower right and use the popup to direct to the printer you want to use. 11. Click the red and white X to exit. 148 P a g e

149 149 P a g e

150 Progress Notes Opening a New Progress note There are several ways to open a new progress note. 1. From an existing appointment in the Scheduling Calendar: This is done by right clicking on the appointment and then clicking SC General Purpose Progress Note. 150 P a g e

151 2. From the My Calendar Widget 151 P a g e

152 3. From the Chart Overview, in the far upper right corner, click add to open a new progress note. (The add link is very tiny and faint.) All of the above methods will open up a note for a preselected client. When you open up a note using one of the above methods, the client's name and (if any) appointment information will be automatically added to the progress note. A blank progress note can also be opened by simply double-clicking the progress note form in the Forms & Data Widget. 152 P a g e

153 Writing a New Progress Note IMPORTANT: You must enter information and click items in order, or the form may not function correctly. 1. Select Client: If needed, add the client s name. Once you have opened the SC General Purpose Progress Note form, add the client s name in the Select Client field. (If you open the progress note from a Scheduling Calendar appointment, or from the Inquiry View in the chart, the client s name will already be in the note.) 2. Select Episode (Admission Program) If needed, select the Episode. If you have opened from the chart or from an appointment, this information will already be in the note. In the Drop-down list, select the Admission Program, e.g. LE00044 MH COUNTY OUTPATIENT or County ADP Prevention HSA. (If you open the progress note from the Inquiry View in the chart, the episode will already be in the note.) IMPORTANT: Make sure you select the correct episode for your note. Your note will be misfiled under the wrong program if you make an error with the Admission Program. Also, if you write your note and then change your mind about the admission program, all of the data you already entered will be erased. 3. Progress Note For: Indicate whether this is an Existing Appointment or a New Service. If you click Existing Appointment, a list of available appointments from the Scheduling Calendar, for this client, will pop up in the menu below, "Note Addresses Which Existing Service/Appointment." 153 P a g e

154 4. Progress Note Purpose: Indicate either Outpatient Note, Residential Note or Information Note. Depending on which one of these you select, different parts of the progress note will be enabled or disabled. 5. PRACTITIONER(S)/TIME: Enter a duration for both Face-to-Face time and Other Time. Avatar will total the time under Total Duration. Enter the time in minutes. Note that Face-to-Face time is the time spent in direct contact with the client. Other Time is non-face-to-face time associated with the appointment, typically, time spent writing notes and travel time. Phone contacts and contact with anyone who is not the client, including parents and guardians, should be noted as Other Time. If you have questions, consult with your supervisor about which services are allowable for Other Time under your Service Program. 6. Service Information: The field for Service Charge Code will provide a list of options once you begin typing. You can type in a search word or phrase, like case management, or type in all or part of the code. For example, type "M" for a list of all mental health codes that are available to you. You must enter data in this section in the following order, or the form will not work: Date => Location => Service Program => Service Charge Code 154 P a g e

155 If there is a service program or service code that you think you should be able to enter, but it does not pop up when you enter data, contact the computer help desk at x4657 or hsamhhelp@co.santa-cruz.ca.us 7. Evidence Based Practices/Service Strategies: enter the appropriate practices and strategies based on the requirements of your workflow. Check with your supervisor to find out if any of these apply. 8. Language: Enter the language in which the service was provided. Click "No" for English. Click "Yes" for other languages. If you click Yes, you will also indicate whether or not an interpreter was used, and the language. 9. Treatment Plan Elements section: If there is a treatment plan for the client, you will select which plan elements the service you provided addresses. 155 P a g e

156 a. Start with the Select Treatment Plan Version menu to select which plan type you want. Click on the question Select Treatment Plan Version, and menu will pop up with the various treatment plan types. Mental Health staff should choose the SC MH Episodic Treatment Plan. DO NOT USE the (OLD) SC MH Treatment Plan. DO NOT USE the SC MH Short Term Treatment Plan unless you work at Telos or EDC, which are short term adult residential treatment programs. Mental Health staff should not use the SC ADP Treatment Plan which is exclusively for substance abuse treatment programs. b. Click Select T.P Item Note Addresses, which will open a view of the treatment plan. c. Click once on the Treatment Plan intervention you want to use to highlight in green, then click Return. Avatar will add everything above what you select, up through the associated problem. 156 P a g e

157 d. Click Return. You will now see the items you selected in the box labeled Note Addresses Which Treatment Plan Problem box. The Clear Note Addresses Which Treatment Plan Problem Text button allows you to clear the treatment plan item you selected if you made an error. 10. Progress Note Section a. Note Type: Select the type of note. 157 P a g e

158 a. Write the note text in the blanks that are enabled (not greyed out). Special types of notes: Some notes, such as the information note or the residential note will only have the Intervention section enabled. Information note: This replaces the Memo type note in previous EMR systems. It is a place to note important information that is not associated with a billable service. Example: a message from a client s family member letting the clinician know the client has been hospitalized. Example: client called to cancel her appointment because she is moving out town and she no longer wants services. Use the service code M001 (mental health) or A001 (SUD) for an information note. 11. Draft/Final and File Note: Once the note has been written, you may select Draft or Final and then click file note. a. Draft: An item will be added to your To Do List to remind you to complete and finalize the note. Clicking on the Form Name in your To Do items will launch your draft the progress note for you to complete. 158 P a g e

159 IMPORTANT: In your My To Do s DO NOT click Review To Do Item. This will not launch the progress note. In addition, you have started down a path that will delete the reminder without your completing the note. Also, if the chart is still open, this function will not work. (The chart must be closed for the draft notes to be relaunched.) b. Final: if you select Final, a picture that will be launched for you to proofread. Use the large blue arrows at top left to page through the document. After proofreading, you have three options: 159 P a g e

160 1) Accept: Accepts the note as final. You will now see a prompt asking you to enter your password. Type in your password to sign the note. Once you sign, you are done with the note. Santa Cruz Avatar 2) Reject: Rejects the note so that you can return it to draft status for editing. Once you get back to the note, click Draft, to continue editing. 3) Accept and Route Accepts the note and routes it to a supervisor and/or one or more approvers for a cosignature. See the next section for more information on Document Routing. 160 P a g e

161 Document Routing In Avatar, you can route a document to one or more people to review the document and co-sign. Talk to your supervisor about whether or not you should be routing documents to her or to someone else. Typically, if you are not an LPHA (licensed, waivered or registered) you will need to route documents to your supervisor or another licensed person for co-signature. 161 P a g e

162 How Do Supervisors and Approvers Work in Document Routing? The document goes to the Supervisor first. When the Supervisor signs the document, it then goes to any Approvers. There can only be one Supervisor. There can be multiple Approvers. Only after the Supervisor signs, does the document gets routed to any Approvers. Once routing has been set up, click submit. 162 P a g e

163 Print a Copy of a Progress Note In Avatar, as with other electronic medical record systems, it is not necessary to print your note. Avatar keeps your notes and other documentation secure. If you do need a copy, use the following directions. After you are finished using your printed copy, shred it as it contains confidential information. 1. Open the client s chart 2. Click the link for the progress note type you want to view. On the left side of the chart overview, you will see a list of progress note types. Click either SC General Purpose Progress Note, SC Med Service Progress Note or SC Group Service Progress Note. 3. Click on the Admission Program tab at the top of the screen. This will bring up a pre display where you can select a Progress Note to print. 4. Use the Sort/Filter buttons to help narrow down the search if there are a lot of notes. 5. Click Print. At top left of the note, you will see the word Print. Click this to print the document. Writing a progress note to document your service for an Assessment or Treatment Plan 163 P a g e

164 In Avatar, Assessments and Treatment Plans do not have a service or billing component built into the form. Therefore, you must write a progress note to account for the time spent meeting with the client and writing the assessment or treatment plan. Below is information about the unique characteristics of writing this type of note. See above for more detailed information on writing a routine progress note. 1. Progress Note Purpose: Click Outpatient Note. 2. Duration: Other Time is non-face-to-face time that is associated with provision of service including writing notes, travel time and reviewing any documentation prior to the appointment. For an assessment or treatment plan, Other Time may be significant compared to Face-to-Face time. (FQHCO Services: If you bill FQHCO, you can only bill for Face-To-Face time. Leave Other Time = 0.) 3. Treatment Plan Elements section: Skip this section. This section will not apply to your note documenting the creation of a treatment plan or an assessment. 4. Progress Note Section a. Note Type: Select Progress Note. b. Write the note in the content blanks that are highlighted. c. If the note documents face-to-face time, indicate the client s presentation and response in the appropriate blanks. For the intervention, indicate that you worked on or completed an assessment, or treatment plan, with the client. d. If the note documents time spent writing the assessment or treatment plan, and the client was not present, enter NA in the blanks for client presentation and response. 164 P a g e

165 How to Tell If There are Draft Progress Notes in a Chart The next few sections of this manual address Draft Progress Notes. This section explains how to figure out whether or not there are outstanding draft notes in a chart. You might want to do this if you have accidentally deleted the link to your draft notes from your My To Do's. Or, you are trying to close the episode, want to make sure that there aren't any outstanding draft notes before you do this. Draft notes cannot be completed once the episode is closed. 165 P a g e

166 STEPS: 1. Open the client's chart. 2. Click on the link on the left for one of the three Santa Cruz Avatar Progress Note types, for example, SC General Purpose Progress Note. You will now see an Inquiry View for this progress note type. 3. Click on the episode where you want to look for draft notes. 4. In the Sort/Filter buttons at the top of the inquiry view, click the rectangular button labeled, "Draft/Final." 5. If there are Draft notes in the episode you've selected, you will see a Draft option to click. If there aren't any Draft notes, you won't see this option, all you will see is Final. 6. Click, "Draft," to view the draft notes for this client, this episode. 7. If these are your draft notes, click, Edit, in the upper right, to complete the note. See below for more information. Reopening a Draft Progress Note If you save your note in draft, a link to the draft note will be sent to your My To Do's. You can open up the draft note from there to complete it. Note that if the chart is still open, the link in your My To Do s will not work. (The chart must be closed for the draft notes to be relaunched.) IMPORTANT: When reopening documents, such as draft notes, in your My To Do s DO NOT click Review Draft Item. This will not launch the note. In addition, you have started down a path that will delete the reminder without your completing the note. 166 P a g e

167 If the link to your draft progress SC General Purpose Progress note or your SC Med Service Progress Note is not in your My To Do s, you will have to open it up from the chart. Unfortunately, you cannot open draft group notes in this manner. STEPS 1. Open the Client s Chart 2. Click on the link for the progress note type. In the example below, the SC General Purpose Progress Note link is clicked. This will bring up a the inquiry view where you can see the notes. 3. Click on the tab for your Admission Program. In the picture below, the selected admission program is episode 4: LE MH COUNTY OUTPATIENT. You may need to use the tiny triangles at the upper right to scroll among tabs. 167 P a g e

168 4. Locate the Draft Progress Note you would like to delete and select Edit. The Progress Note will open. Observe the highlighted areas (client name, episode, draft note information) and verify that this is the Draft Progress Note you want to edit. 5. Complete your note. 6. Select Final at the bottom of the page. 7. Select File and follow the steps to sign and/or route the note. 168 P a g e

169 What To Do if the Link to Your Draft Progress Note is Missing From the Chart If you save your note in draft, a link to the draft note will be sent to your My To Do's. If you accidentally delete this link, or it disappears, normally, you can open up the draft from the chart, by clicking, "Edit." (This only works for individual notes. It will not work for Group Progress Notes.) Sometimes, this "Edit" link disappears. If this happens, you can try searching for it from an open blank progress note, using the "Select Draft Note To Edit," field. STEPS 1. Open the client's chart and click on the Progress Note Type at upper left. 2. Then click the Episode Tab where the note is. 169 P a g e

170 3. Click "Add" in the upper right-hand corner of the chart. This will open a new progress note. 4. Click, "Select Draft Note To Edit." This will open up a menu of available draft notes for this client, this episode. 5. In the menu, click on your draft note to load it into the form. You will now see your note information displayed in the "Select Draft Note To Edit" drop down and the data from your draft note should now be loaded into the progress note form. 6. Edit your note. 170 P a g e

171 How to Delete a Draft SC General Purpose Progress Note or SC Med Service Progress Note If you make an error and your progress note is still in Draft form, you can delete the note yourself. There are a couple of things that you should know about this process: 1. This will only work for the SC General Purpose Progress Note or the SC Med Service Progress Note. (Group notes cannot be deleted this way. See the section titled, Group Progress Note Corrections, for more information.) 2. Only the original author of the draft note can delete the note in this manner. The helpdesk or QA cannot delete it for you. 3. If you have a note that has been Finalized and Filed, you will need to send a message to askqi@santacruzcounty.us to have the note deleted. You cannot delete it using the following method. Avatar sends draft notes to your My To Do's. If the note is still in your My To Do's you can open up the note from there to delete it. If the reminder in your My To Do's as disappeared, you will need to open up the note from the chart. Steps for Opening Up a Note from the Client s Chart (You only need to do this if you have accidentally deleted the link to the note from your My To Do s.) 1. Open the Client s Chart 2. Open up the Inquiry View for the Note Type. On the left, click on the link for the progress note type. In the example below, the SC General Purpose Progress Note link is clicked. This will bring up a the inquiry view where you can see the notes. 3. Click on the tab for your Admission Program. In the picture below, the selected admission program is episode 4: LE MH COUNTY OUTPATIENT. If there are many, many tabs you may want to return to the chart Overview (click the word "Overview") and look at the Episodes widget to find the episode number. This will help you locate the correct tab. You may need to use the tiny triangles at the upper right to scroll among tabs. 171 P a g e

172 4. Locate the Draft Progress Note you would like to delete and select Edit. 172 P a g e

173 The Progress Note will open. Observe the highlighted areas (client name, episode, draft note information) and verify that this is the Draft Progress Note you would like to delete. 5. Select Delete Draft Note to delete. How to Delete a Draft SC Group Progress Note For group note deletions the entire group will need deleting and then must be re-entered. Group draft notes cannot be deleted by the clinician. (There is no "Delete" button in draft notes.) If you need group draft notes deleted, you must finalize the notes first and then request a deletion. Put NA or Void in the text blanks of the note. 173 P a g e

174 See the section titled, Group Progress Note Corrections, for more information. Using the Append Progress Notes Form to Add to a Progress Note If you have already filed and signed a note, Avatar does provide an opportunity to add to the text of the note, or note content, using the Append Progress Notes form. Service information, like time spent and service code cannot be altered this way. Once the Append form has been completed, the added text will appear as an addendum at the end of the Progress Note in Avatar. If you need to void (delete) a note, change the service code, or change the duration, we can revert the note back to draft for you so you can change it. If you entered the note under the wrong name, or the date is wrong, the note will need to be deleted and you will need to rewrite it. See the section titled, Corrections: What To Do If You Make a Mistake. To avoid having to add to or make changes to services, it is important to take time to look over your notes before finalizing them. To Use the Append Progress Notes Form: 1. Select the Append Progress Notes form. A Select Client window will open up. Enter the name or number of your client to open the form. 2. You will next see a pre-display of the client s episodes. Select the appropriate episode. 174 P a g e

175 3. Select the Note Type or category of your note. 4. In List of Notes, select the note you wish to append. IMPORTANT: If you have routed a progress note to a supervisor and are waiting for a co-signature, the progress note will not appear in the List of Notes. Ask your supervisor to Reject the note, which will put it back in your My To Do s in Draft form. You can then make your changes and submit the note again. Once you have selected the note you want to append, the Original and Appended Notes section of the form will be populated with information from your Progress Note. In terms of note content, only the Intervention portion of your original note will be shown here. This does not mean that the Client Presentation, Client Response and Follow-Up sections are not there, just that you cannot see them in this particular window. 175 P a g e

176 5. In the New Comments to Be Appended to the Original Note section, add your comments. You may want to add a notation about which section of the note your comments belong to because your addendum will be at the very end of the note. 6. Click Submit. Once you have submitted the form, your changes will show at the end of the note when the note is printed and when the note is viewed in the chart. 176 P a g e

177 Group Progress Notes There is a separate document explaining how to create Group Progress Notes on the Santa Cruz Avatar Webpage. See this document for more information. Indirect (MAA) Service Note Consult with your supervisor about whether or not you should be using this note. MAA Billing is used by staff when performing activities that inform eligible or potentially eligible individuals about Medi-Cal services, including explaining how to access these services, describing the range of benefits covered, and how to obtain services. MAA notes should not contain clinical information about the client, but rather describe the outreach activities by the clinician. These notes do not connect to any particular client chart only to the practitioner. 1) Open the Indirect (MAA) Service Note. Click in the Search Forms field in your Forms & Data Widget and type Indirect (MAA) Service Note. Double click on the form name to open up the form. 2) Enter Date of Service, Practitioner (your name), Program, Service code (indirect MAA service) and Duration. 3) Fill in the Indirect Service Note field if needed. Consult with your supervisor about whether or not you need to write anything in the Indirect Service Note blank. Avatar does not require you to fill out this field to complete the note. This field is intended to record a brief summary of the indirect services provided by the clinician. It is not a clinical note and should not contain client information. 177 P a g e

178 4) Click Submit. Shared Treatment Planning Integrated treatment planning is part of the movement toward integrated care. An integrated treatment plan shared across teams and providers creates improved opportunities for coordinated treatment planning and service provision. Integrated treatment planning allows multiple treatment providers to set shared goals. The goals are set within the context of the multiple treatment modalities the client may be receiving at any given time. Integrated treatment has been shown to improve outcomes such as: reduced substance use, improved psychiatric symptoms and functioning, decreased hospitalizations, increased housing stability, fewer arrests and improved quality of life. In Avatar, Santa Cruz County Behavioral Health uses treatment plans that contain goals and objectives that may be shared across teams and providers within a single episode with everyone adding goals, objectives and interventions as needed. 178 P a g e

179 Treatment Plan Types in Santa Cruz Avatar There are three current treatment plan types in Santa Cruz Avatar as discussed below. You will use one of these forms to create your treatment plans. SC MH Episodic Treatment Plan Although not shared among all mental health providers and agencies, The SC MH Episodic Treatment Plan is shared within an LE or agency. Providers within each LE agency all add to the same plan. SC SUD Treatment Plan This plan is used by SUD programs and is shared only among providers within a specific treatment program. SC MH Short Term Treatment Plan This plan is for the exclusive use for adult mental health step down facilities, Telos and El Dorado Center. (OLD) SC MH Treatment Plan This is the previous plan used by mental-health systems. This was a non-episodic plan shared among all mental health providers for single client. Beginning 3/1/17, mental health providers began using the Episodic treatment plan. The old non-episodic mental health treatment plan can still be seen in client charts. Definition of Episodic versus Non-Episodic Forms: Episodic Forms: Episodic forms in Avatar are attached to an episode. Examples are our progress notes and the psychosocial assessment. In the chart you can see the open episode tabs arrayed across the top of the progress note view. 179 P a g e

180 Non-Episodic Forms: Non-episodic forms are not attached to any episode. CANS ANSA is a non-episodic form. In the chart you can see that there are no EPISODES attached to the form. The Current/History tabs show the current (most recent) version and past versions of the form but no episodes. SC MH Episodic Treatment Plan Overview Steps in Creating Sequential Integrated Plans Although multiple providers at an agency all add to the same plan, the plan is not kept in draft. In order to add to an existing plan, the user makes a copy of the plan (using the default method that will be explained later) and then adds their changes, finalizing the plan after signatures are obtained. In this way, all of the providers stay in the shared plan. The most recent plan will contain goals, objectives and interventions added by all providers. Definition of Legal Entity or LE A Legal Entity or LE defines an agency under which different teams, programs and providers operate. The episodic treatment plan is created under an LE. That means, if you have other users under your LE who are also working with the client, you will share a treatment plan with those users. You will not share a plan with others who provide services under a different LE. Example: If there is a county case manager and a county therapist, they will both contribute so the same plan under LE MH COUNTY OUTPATIENT. If the same client is getting day services and housing support from Encompass, those providers will have their own unique plan under LE ENCOMPASS OUTPATIENT. LE's are as follows. LE MH COUNTY OUTPATIENT LE MH ENCOMPASS OUTPATIENT LE MH FRONT STREET OUTPATIENT LE MH FAMILY SERVICES OUTPATIENT 180 P a g e

181 LE MH PARENTS CENTER OUTPATIENT LE MH PVPSA OUTPATIENT LE MH VOLUNTEER CENTR OUTPATIENT Note that Telos and El Dorado Center have treatment plans that are separate from other Encompass programs. These programs use a separate form, the SC MH Short Term Treatment Plan. They are not part of the shared plan for the Encompass LE. All others participate in a shared plan under their agency s LE. The episode names for these two programs that have their own plan are. Encompass Telos Crisis Residential Encompass Adult El Dor ado Residential Integrated Treatment Planning and Due Dates for the SC MH Episodic Treatment Plan Anniversary Date: The Authorization Start Date (formerly Plan Date) for the SC MH Episodic Treatment Plan is shared by providers within an agency. The Anniversary date is the anniversary of the opening date for the episode or current LE. As clients are opened to new services within an LE - problems, goals, objectives and interventions are added to the mental health treatment plan (or removed if they no longer apply or have been resolved). All items, no matter when they are added, expire the day before the anniversary date, on the Authorization End Date (formerly Plan End Date). If a new goal, etc is added in the middle of a client's authorization period, which lasts a year, that goal will still expire one day before the Authorization End Date. This means that some goals, objectives and interventions may be in effect for less than a year. For example, a new client is opened to the LE Admission Program on July 15, The client is referred to case management. The case manager completes a treatment plan. The goals initiated by the case manager are valid from July 15, 2017 through July 14, Then, on September 15, 2017 the client begins psychotherapy. The psychotherapist creates an Update, adding treatment plan goals, etc to the treatment plan already in effect. Those psychotherapy goals are in effect from September 15, 2017 through July 14, P a g e

182 Admission Date = 7/15/17 Initial Treatment Plan Dates: Jul 15, 2017 to Jul 14, 2018 Plan Name: 7/15/2017-7/14/2018 Initial Authorization Start Date: 7/15/17 Authorization End Date: 7/14/18 Treatment Plan Update 1 Date: A new goal, objective and intervention is added on September 15, 2017 Plan Name: 7/15/2017-7/14/2018 Update 1 Authorization Start Date: 7/15/17 Authorization End Date: 7/14/18 Annual Expiration Date for All Treatment Plan Goals Everyone Updates Plan, adding and resolving goals, etc... Dates: Jul 15, 2018 to Jul, 14, 2019 Plan Name: 7/15/2018-7/14/2019 Annual Authorization Start Date: 7/15/18 Authorization End Date: 7/14/19 Plan Page and Plan Builder Page There are two pages to the Treatment Plan form. On the first page, the PLAN PAGE, the following items are addressed: Plan name dates type of plan client strengths/challenges plan participants problems to be addressed (diagnoses) The second page, the PLAN BUILDER PAGE of the treatment plan is opened by clicking the "Launch Plan Builder button. This is the area where Goals, Objectives, and Interventions are written. Treatment Plans for Monolingual Clients For clients who do not speak English, the clinician should type both English and Spanish (or other language) into the plan. The format is [English text] / [Spanish translation text]. For each item, the English first, then a slash, then the Spanish text. 182 P a g e

183 BEFORE YOU START YOUR MH EPISODIC TREATMENT PLAN Before creating your treatment plan, make sure that you understand the dates you are going to use, the title or plan name you are going to use, and your anniversary date. Anniversary Date? Authorization Start Date? Plan Name? Look at the client s chart to see if others have already started a plan. If so, you will create a Treatment Plan Update. To create an Update, you need to follow specific steps to make sure that everyone is included in your version of the plan. Make sure you know the name and plan date of the plan that you are going to add to. You don t want to pick the wrong plan. If you are not sure, consult with your supervisor, a local superuser, or contact the QA department for advice. It's much easier to get help in advance, then to have to make corrections later. Contact the QA department at askqi@santacruzcounty.us or call If your plan is not created correctly, it might need to be deleted and you will have to do it all over again. The instructions contained in this document show you how to create an initial treatment plan, updates, and an annual plan for a new client. Creating an Initial MH Episodic Treatment Plan The Initial Treatment Plan is the first treatment plan for any client coming into services. A client will only have one Initial Plan. After creating an Initial Treatment Plan, Updates are created throughout the year. An Annual Plan, is created once per year, and is due on the anniversary of the opening date to the current LE Episode. The information below assumes that this is a new client to Avatar, with no prior episodic treatment plans. 183 P a g e

184 STEPS: This shows you how to create a plan for a brand new SC MH Episodic Treatment Plan for a client who does not have one. If you are doing this as part of a training exercise, use a client that does not have any existing episodic treatment plans. 1. If you have not already done so, open your client's chart. In the chart view, find a link for SC MH Episodic Treatment Plan. Double-click on the link. Click on the tab for your LE. This will open up the display area or Inquiry View, for any previously written treatment plans. You should see a blank page because no treatment plan has yet been written for your client. You should see, No Data Found, in the inquiry view. 2. Look at the opening date for your LE. For example, if you work for County Mental Health, look for the tab labeled, LE MH County Outpatient. If you work for the Volunteer Center, look for the tab labeled, LE MH VOLUNTEER CENTR OUTPATIENT. 184 P a g e

185 3. With your LE tab selected, in the far upper right hand corner of the chart view, click on Add to create the first treatment plan for your client. The first page of the Treatment Plan form will open. 185 P a g e

186 Plan Naming Conventions The first question in the plan asks for a plan name. Below are instructions on how to write this. Plan Names indicate the annual authorization period for the plan (when the plan year starts and when it ends) and what type of plan it is (initial, annual, update). [Authorization Start Date] [Authorization End Date] [Plan Type] [#] Because goals may be added throughout the plan year, it is important to give plans names that identify and differentiate them from each other. Each time new goals are added, the plan is given a new name. Each new plan, with its new goals, interventions and/or objectives has a different name to separate it from the prior plan. Double Check Your Episode Examples of Plan Names 04/05/17 04/04/18 Initial 04/05/17 04/04/18 Update 1 04/05/17 04/04/18 Update 2 04/05/18 04/04/19 Annual 04/05/18 04/04/19 Update 1 04/05/18 04/04/19 Update 2 TIP: Once you have your plan open, look at the Episode information at the top of the chart, next to the client's name. This is a good double check to make sure you have selected the right episode. START ENTERING DATA INTO YOUR PLAN If you are creating a plan as part of a training exercise, choose an initial date at least one month ago. (After you create this plan, you will create an updated plan using today's date.) 186 P a g e

187 STEPS: 1. Enter the Plan Name (see above for plan naming info). 2. In the Plan Type field, click the down-arrow to reveal the drop-down menu. Single-click to select Initial. Note the MH Treatment Plan Documentation link which points to helpful clinical information about filling out a Treatment Plan. At this point, the Last Updated field and the Last Updated By field are disabled and blank. Once you have saved the plan in draft, your name will be here and the date you updated the plan will be automatically entered. In the Authorization Start Date field, enter the beginning date of the plan, which is the opening date to your LE. (See the chart tabs to get the date if you forget.) Type in the date or use the calendar icon to select a date, then tab or click out of the field. The Authorization End Date and Next Review Date should auto-populate after tabbing out of the Authorization Start Date field. The Authorization End Date will automatically be entered as one year minus one day from now. The Next Review Date will be one month before the Authorization End Date. On the Next Review Date, a message will be sent to you in your My To Do s, reminding you that the plan is due. 187 P a g e

188 3. Answer the required question Was This Treatment Plan Discussed in a Language Other Than English? If Yes, complete the required fields Language and Interpreter or Bilingual Provider? 4. Skip the questions, Date client was offered a copy of the treatment plan, and Additional Comments About Client s Support System. You will get back to these later. Problems Table You will add each of the client's problems as one line or row on the table. When you open up the plan, you may find that there are already problems in the Problems Table. These problems come from the diagnosis form, prior episodes and prior treatment plans (including the non-episodic SC MH Episodic Treatment Plan). You do not have to use these problems if you don t want to. You may add problems as shown below. You may use a combination of pre-existing problems and new problems that you add. Use the scroll bar on the bottom of the table to navigate across each row in the table. For training purposes, you will practice adding a new problem. 188 P a g e

189 STEPS for the Problems Table 1. Enter a new problem by clicking the New Row button. For each problem added, you must create a new row in the table. 2. Type in a problem in the column titled "Problem." Then click Enter on your keyboard. A list of potential diagnoses/problems will pop up. You can enlarge this window containing the list of diagnoses by clicking and dragging in the lower right-hand corner of the pop up window. Click on the diagnosis/problem you want in your table. The selected/chosen problem will be entered in the Problem field. Be patient when typing your problem. It can take a few seconds or so for Avatar to search the data base of problems, which is internet based. Make sure you press, enter after you type the problem. Notice that the Date of Onset and Status fields are outlined in red. This is because these fields are required. You will not be able to finalize and submit your treatment plan of these fields are empty. SNOMED CODES In Avatar treatment plans, the problems you address can be Diagnoses or functional impairments such as disorganized thought process, poor motivation, or social isolation. The SNOMED codes that you add to your plans cover both diagnoses and functional impairments. Only licensed/waivered/registered staff can add or treat Diagnoses. If you are licensed/waivered/registered, you can use either a diagnosis or a functional impairment type SNOMED code in your plan. If you are not licensed/waivered/registered, use SNOMED codes that address a functional impairment associated with one of the client s diagnoses. For example, if your client has the diagnosis of depression, you might choose the SNOMED code, social isolation. 3. DO NOT USE THE TYPE FIELD. 4. Double-click in the Date Identified field to activate the field. This is an optional field. Enter a date if appropriate. 5. Enter the Date of Onset. THE DATE OF ONSET IS NOT THE OPENING DATE FOR YOUR PROGRAM. Typically, you will not know the exact date of onset. Pick the closest approximation that you can for the year. Month and day are January 1 st. For example, 01/01/ Status field: For a new problem, the status will be ACTIVE. This is a required field. DO NOT put Monitoring or Inactive as the status for your problems. If you do this, any goals, objectives or interventions associated with this problem will be invalid. (If you no longer need a problem, you can resolve it.) 7. Severity field: This item is optional. To activate the field, double-click on the entry of your choice, or single-select the item of your choice and click the Select button. 8. After adding all of the client problems, if appropriate, in the Include in this plan? column, check on all the checkboxes for those problems you wish to include in this treatment plan. Note that you do not have to use all of the items in the problems table, only the ones you want to address in the treatment plan. 189 P a g e

190 9. IMPORTANT: You must add your problems on this page. Do not add problems on the plan builder page, which is the next page, where you add your goals, objectives and interventions. STEPS for the Plan Participants Section The Plan Participants table is where you enter everyone who signs the plan (client, parent, guardian, conservator, LPHA, etc ). Each of the plan participants is added as one line on the table. Enter a new participant by clicking the New Row button. TO ENTER YOURSELF: 1. Double-click in the Role field to activate the field. Click Staff in the pop-up window. 2. In the Staff ID field type in your last name and click enter. If you are the only person with that last name, your name should automatically auto populate into Staff ID and participant Name fields. Otherwise, you will see a list of names. Double-click on your name to enter yourself into the table. 3. Enter Yes in the Plan Author field. 4. Enter Yes in the Notification field. By doing this, you will set up a notification reminder for when the treatment plan is due next year. This reminder will appear in your My To Do s on the notification date. TO ENTER AN LPHA: If there will be a co-signer for your plan, then enter the name of your LPHA staff member. This will only work if the LPHA is a user in Avatar. 1. Double-click in the Role field to activate the field. Click LPHA in the pop-up window. 2. In the Staff ID field type in the last name of the LPHA and then double-click on the name. 3. Enter No in the Plan Author field. 4. Enter No in the Notification field. TO ADD YOUR CLIENT: 1. Click New Row. 190 P a g e

191 2. Double-click in the Role field to activate the field. Click Client in the pop-up window. 3. Skip the Staff ID field. (There won t be a staff ID because this is not a staff person.) 4. In the Participant Name field, type the name of the client. 5. Enter No in the Plan Author field. 6. Enter No in the Notification field. TO ADD A PARENT, GUARDIAN, CONSERVATOR OR OTHER PARTICIPANT: 1. Click New Row. 2. Double-click in the Role field to activate the field. Click PARENT/GUARDIAN, CONSERVATOR OR OTHER in the pop-up window. Use OTHER for anyone who does not fit in the PARENT/GUARDIAN or CONSERVATOR category. 3. Skip the Staff ID field. 4. In the Participant Name field, type the name of the participant, and their role. Type in the name AND a word or short phrase to explain who this person is if this is not clear from the role type. Examples: Janet Williams, Social Worker - OR Lisa McDougall, LPS conservator. Make sure you add the correct role for these participants, and any needed descriptive information in the Participant Name field. YOU may know that the Janet Williams is the mother, but other people may not. If it is not clear who these people are, then we don't know if the plan is valid. 5. Enter No in the Plan Author field. 6. Enter No in the Notification field. Continue adding participants to the plan. It is appropriate to add parents, foster parents and legal guardians. Add anyone who is going to sign the plan. Plan participants are anyone who holds the privilege for the client as well as anyone who is actively working with the client on progress toward the client s goals and objectives. Examples are: parent, guardian, conservator. 191 P a g e

192 Plan Participants are anyone that signs the plan. Don t add anyone that doesn t need to sign the plan. If you want to discuss other supports, such as a day program, school staff, etc (people who don t sign the plan) add this information about the client s support system in the question, Additional Comments About Client s Support System. Signature Field: If you have an electronic signature pad available, once you have added all of your goals, objectives and interventions, you will click Sign to activate the signature pad for your client to sign. Once the client signs the signature pad, Avatar will import the signature(s) into the document. However, don t obtain the signature(s) until you have completed the plan. IF YOU DO NOT HAVE A SIGNATURE PAD OR YOUR CLIENT CANNOT COME INTO THE OFFICE: Once you have completed a draft of the plan, you will print out a copy of the plan, have the client sign the plan and then the plan will be scanned into the client's chart. See the next section for more information about workflows with printed treatment plans. Continue filling in fields in the plan: 1. Add Additional Comments About Client s Support System as needed. 2. Add information about the client s Strengths and Challenges in the appropriate fields. You will not be able to move on to the second page of the Treatment Plan unless you fill in these fields. 3. In the Treatment Plan Status field, select Draft status radio button. Then click the CLICK HERE to Launch Plan Builder button. This will take you to the second page of the form, the Plan Builder Page. This is where you will add your goals, objectives and interventions. Plan Builder Page You should now see the Treatment Plan Builder portion of the form with your problems from the Problems Table on the first page displayed. (TIP: If you don t see your problem, it s possible that you forgot to check it off in the problems table.) 192 P a g e

193 IMPORTANT: Remember, do not add problems on this page. If you decide you need another problem, go back to the first page and add your new problem into the problems table. Red Flags: The red flags you see tell you that the item has not been completed. As you write the treatment plan goals, objectives and interventions, use the red flags to help you see items you may have missed. All of the red flags must be gone before you can finalize and submit your treatment plan. 1. Click on one of your problems to highlight it. The problem selected will be highlighted green. 2. In a field in the lower half of the page, you will see your problem written out. You may add to this problem to make it more specific if you like, but DO NOT ERASE THE PROBLEM. Add text to the problem as shown below. Your problem might start out looking like this. Do not erase it. You may edit it as shown in the example below. 193 P a g e

194 Entry Date: This field will automatically populate to today s date. Staff Responsible: You should see your name automatically added to this field. 194 P a g e

195 3. Click Add a New Goal: With the Problem you want still highlighted in green. Click Add New Goal and a blank goal will pop up for you to write in. IT IS VERY IMPORTANT TO CLICK ON THE PROBLEM, GOAL, OBJECTIVE ABOVE WHERE YOU WANT THE NEXT ITEM TO BE, SO THEY ARE ASSOCIATED CORRECTLY WITH EACH OTHER. In the example above, the Problem: Recurrent major depression, moderate, is highlighted in green. This must be highlighted like this to write a goal for this particular problem. Enter the text of the goal in the field titled Goal. Entry Date: This field will automatically populate to today s date. Staff Responsible: You should see your name automatically added to this field. 4. Add a New Objective: You will now add a new objective to the goal you just wrote. 195 P a g e

196 First, click on the goal you just wrote to highlight it. Click the text of your goal at the top of the page. The text of the goal should now be highlighted in green. This way, your new goal will be connected to the new objective. Click the Add New Objective button to open a blank objective. Notice how the new objective is underneath your goal and is indented. This tells you your objective is connected to the goal above it. 5. New Intervention: You will now add your Interventions to the Objective you just wrote. Make sure you click and highlight in green, the text from the Objective you just wrote, before clicking Add New Intervention. 196 P a g e

197 Once you have added your goals, objectives and interventions, return to the Plan Page (the first page) Click Back to Plan Page once you are done writing your goals, objectives and interventions. Remember, all of the red flags should disappear if you have filled in all the required fields. Note that you will not be able to finalize your plan if you have left any fields blank on this page. Use the Electronic Signature Pad to Obtain Signatures If the client, parent, guardian, etc are present, use the electronic signature pad to obtain signatures. If desired, you may also have the person signing write the date when signing. Although not required, this date is a confirmation of when the signature was obtained. 1. First, make sure that you have a signature pad and that it is plugged into your computer. 2. Click the word, Sign, at the end of the row in the Plan Participants table. This will launch the signature window. 3. Hand the signature pad to the person you want to sign. 4. After the person has signed, Click OK to add the signature to the plan. 197 P a g e

198 Once the signature has been captured, you will see a check mark in the row with the name of the person who signed. In the chart, and in printed copies of the plan, you will now be able to see the signature OPTIONAL: You may have the client date the signature if this makes sense for you in terms of workflow. 198 P a g e

199 IMPORTANT: We have found that when adding multiple signatures, it works best to capture one signature, then submit and reopen the plan. If you do not do this, sometimes, one of the signatures that you have captured will disappear. In other words, do the following: 1. First person signs and dates the plan using the signature pad. 2. Submit the draft plan. 3. Reopen the plan. 4. Next person signs and dates the plan using the signature pad, etc. 2. Once all needed signatures have been obtained, offer a copy of the plan to the client. Then, in the question, Date client was offered a copy of the treatment plan field, enter the date of signature. See the end of this section for printing instructions. (Leave blank if you are going to take a printed copy of the plan to your client for signature. You will fill in this question later.) IMPORTANT: You must offer the client a copy of the plan and enter a date in this blank. This is a Medi-Cal requirement. You may also save your plan as a draft and have the client sign at a later time. See the next section, Printed Treatment Plan Workflows (what to do if you don t have a signature pad) for more information. 199 P a g e

200 If the client does not sign the treatment plan at all, enter the reason why in the next field labeled, If client has not signed the treatment plan, please explain. (e.g. client is too symptomatic or cannot be located.) If the client has signed a printed, paper copy, enter, Client signed a printed copy of the plan. See scanned plan for signature. You MUST explain why, if the client does not, or cannot, sign. Example: Client was not able to sign due to psychiatric symptoms that interfere with ability to sign this document. Will continue to work with client to obtain signature. If your client refuses to sign or you cannot locate the client/guardian for signature, you must document ongoing attempts to obtain the signature in your progress notes. If the signature is delayed, don t leave the plan in draft for too long. Leaving the plan in draft prevents others from adding to the plan. After a period of time, if you still haven t gotten the signature, go ahead and finalize the plan. You can create another copy if you have another opportunity to get the signature. Next, In the Treatment Plan Status field, select the Draft or Final radio button. Select Draft if you don t have the signature yet. (See above for more information about this.) Select Final after you get the signature. As with other Avatar documents, if you select Draft, the Treatment Plan will show up on your My To Do s to remind you to complete and finalize the Treatment Plan. You can re-open your draft by clicking on the link. Select the Submit button in the Navigation panel on the left to save and close your treatment plan. Final: As with other Avatar forms, like Progress Notes, if you select Final, a picture of the Treatment Plan will be launched for you to proofread. After proofreading, you have three options: Accept, Reject or Reject and Route. You may route to a supervisor and other approvers. 200 P a g e

201 Printing a Copy of Your Treatment Plan 1. Open the client s chart. 2. Click on SC MH Episodic Treatment Plan to open the Treatment Plan Inquiry View. 3. Set the slider at bottom right to about 85% to print out in font that is manageable. If you leave the slider at 100%, the text in your printout will be very large. To Shrink or Enlarge Text in the Inquiry View, at bottom right in the inquiry view, you will see a button that you can slide left and right to increase and decrease the size of the font in the inquiry view. This handy button is also on many forms. 4. Click Print at upper right. As of 9/15/16, the Treatment Plan Report cannot be used. This is because it does not contain the credentials of the person creating the plan, which is a Medi-Cal requirement. Use the Print function to obtain a printed copy of your report for your client to sign. 201 P a g e

202 Printed Treatment Plan Workflows (what to do if you don t have a signature pad) This workflow applies if you do not have a signature pad available. It might be that the client cannot come in to the office and you don t have a laptop with signature capture, or you simply do not have a signature pad at your location (for example, jail). First, print out a copy of your draft treatment plan. Do not finalize the treatment plan until you obtain signature(s). Take the printed plan to your client (and others who need to sign) for signature. The signature(s) should also be dated. If the client (and/or guardian) approves and signs the plan, when you return to the office, turn in the signed paper copy to clerical staff who will scan in the document and route electronically to the client s chart. Once this is done, you will enter information about the signature and finalize the treatment plan. Steps: 1. Complete your treatment plan, leaving it in draft. Leave the question, Date client was offered a copy of the treatment plan, blank. You do not enter anything here until you obtain the signature. SAVE THE PLAN AS A DRAFT. DO NOT FINALIZE. You want to wait to finalize until after you get the client signature. 2. Print out a copy of the plan, using the directions in the previous section. 3. Meet with client, guardian, etc.. to obtain the signatures. 4. The plan is scanned into the chart. County staff should turn in the plan in to the chart room for scanning. You do not need to scan the plan yourself. Contractor staff should consult with a supervisor to find out about scanning procedures. 5. Reopen the Draft Treatment Plan in Avatar. 6. In the question, Date client was offered a copy of the treatment plan, enter the date the client signed. 7. In the blank where it says, If client has not signed the treatment plan, please explain," explain that the client signed a paper plan that was then scanned in. 202 P a g e

203 Important: Do not leave this question blank. You want to make it easy for people to find the signature. Without a signature, your plan is not valid and your services are not covered. 8. Finalize and submit the electronic Treatment Plan to Avatar. Do not forget to finalize the plan. If the plan is not finalized, it is not valid. To View Your Scanned Treatment Plan Links to scanned documents are located in a chart section called Documents. Look for the link that says, CLN Treatment Plan, and click to open. (If you do not see this link, or the documents section at all, you will know that there are no scanned treatment plans in the chart.) Plans are filed by episode. Click on the tab for your Admission Program to find the scanned plans for your program. Creating a Treatment Plan Update (Defaulting Plan Data from a Prior Plan) You will create an update when you want to add new services Example: Client already has a case manager, and you are starting therapy with the client. Example: Your client, who has a history of outbursts, has improved significantly and no longer has these episodes. You want to remove goals relating to outbursts and add something that is more relevant to the client's current status. When you create an update, you are adding to a plan that already exists. If other providers have already started the plan, you want to preserve the problems, goals, objectives and interventions that they have added. You have seen how treatment plan elements are added to progress notes. If you do not bring all current items into your plan, these items won t be available to add to progress notes. 203 P a g e

204 When you do an update, because the current plan is finalized, you cannot open it up to edit it. Instead, you use DEFAULTING. When you default from the prior plan, you essentially make a copy of that plan. This copy will be in draft, and you can add your own items to it. Once you are done with this update, you get signatures and finalize the plan. If you neglect to bring forward treatment plan items by others, you run the risk of your plan being deleted. STEPS: 1. Open the client's chart if you have not already done so. 2. Click SC MH Episodic Treatment Plan in the list of forms on the left in the Chart Overview, then click on your LE tab. You should now see an Inquiry view of the client s Treatment Plan(s) for your LE. Make sure you click the right LE. If you pick wrong, you will have to rewrite your plan and then have the one under the wrong LE deleted. 3. Look through the plans to see which is the most recent shared plan. This is the plan you are going to add to. Make a note of the name and plan date. 4. Make a note of the Anniversary date and make sure that you understand what your Authorization Start Date is going to be. You only get one chance to enter this date, and if you make an error, you will have to recreate your plan and have the one with the wrong date deleted. Before starting your plan, look at the plans in the chart. This is a good opportunity to see if there is anything problematic that needs to be fixed. Shared treatment plans can be complex and there are sometimes errors. You don t want to add to the wrong plan or add to a plan that has been created incorrectly. If you have questions, contact the QI help desk at askqi@santacruzcounty.us or call WHICH PLAN DO I USE FOR DEFAULT INFORMATION? When you create a Treatment Plan Update, you need to make sure that you choose the correct plan from which to default information. This should be the most recent shared plan. An example of a correct set of treatment plans, in sequence, is shown below. 11/20/ /19/2017 Initial 11/20/ /19/2018 Annual 11/20/ /19/2018 Update 1 11/20/ /19/2018 Update P a g e

205 5. Once you have located the plan from which you want to default information, Click Add in the upper right-hand corner of the screen to open a new form. 6. Click Yes when you see the pop up asking if you want to, "default plan information from a previously entered plan. 7. Default From Previous: You will see a second pop up that provides a list of previous Treatment Plans for the client (the long bar with the plan name on it). If there is more than one plan, you want to pick the most recent plan shared plan. 8. Enter Authorization Start Date: You will see a third pop up asking you to enter the Authorization Start Date. The Authorization Start Date always the opening date for your LE, even for Updates. IMPORTANT: You cannot adjust the Authorization Start Date after you enter it in the pop up. Once you open the treatment plan, this date will be greyed out or disabled and you will not be able to change it. Make sure that you enter the correct date, otherwise, you will need to have your plan deleted and then write it again. If you make a mistake, see the box below with instructions on how to correct this error. 9. Once you have entered the Authorization Start Date, click OK. 205 P a g e

206 IF YOU MAKE A MISTAKE WITH YOUR AUTHORIZATION START DATE To Correct the Problem: If the client has not yet signed the plan, it can be deleted. If it has been signed, it is a valid plan, despite the date error, and must be left in the chart. Regardless, you will need to recreate the plan with the correct date. Then, if applicable, submit a request for the plan with the wrong date to be deleted. 1. If you plan is still in draft, change the title to, INVALID or DELETE. This helps the person who is deleting the plan find it. (We don't want to delete the wrong plan!) 2. If the plan with the wrong date is still in draft, finalize the plan. This ensures that no one in else adds any information to it, further complicating the situation. 3. Use the "Default" method to create a new plan that has all of your plan data in it. (See, Creating a Treatment Plan Update, for more information about defaulting from a prior plan.) When you default from the plan with the wrong Authorization Start Date, you won't have to retype everything in your plan. You will just have to redo a few questions. 4. Send a message to askqi@santacruzcounty.us requesting the deletion. We need: Client Name/Number, Plan Name, Authorization Start Date, Reason for Deletion, Episode Name/Number. CONTINUE ON WITH YOUR PLAN. 1. Once you have entered your plan date, you will see a pop up asking if you are sure you want to default information from a previous plan. Click Yes. 206 P a g e

207 2. Enter the Plan Name The plan name contains the whole plan year or authorization period, the plan type and a number if needed. Example If the most recent plan was titled: 10/5/ /4/17 Initial Your plan update will be titled: 10/5/ /4/17 Update 1 Example If the most recent plan was titled: 10/5/ /4/17 Update 1 Your plan update will be titled: 10/5/ /4/17 Update 2 3. In the Plan Type field, you will select Update. 207 P a g e

208 Plan Dates Check to make sure the Authorization End Date is correct. Change this date and then press tab. You will get a warning that essentially says that Avatar is going to recalculate the Next Review Date, which, as you recall, is 30 days prior to the Authorization End Date. 208 P a g e

209 4. Was This Treatment Plan Discussed in a Language Other Than English? This question is prepopulated from the previous plan. 5. Problems Section (Table): In the Problems Section, you will see the client's previously entered problems/diagnoses. You may choose to leave this section as is, add a problem, or check off a problem that was previously left off of the Treatment Plan. Select or add problems according to your treatment needs. You won t be able to uncheck any problems because they are in use for the previously written goal(s), objective(s) and intervention(s). 6. Plan Participants Section: If needed, add your name and any additional Plan Participants. To add yourself or other participants, click new row. 7. Complete the rest of the fields on the Plan Page (first page). CONTINUE ON TO THE PLAN BUILDER PAGE: Click Draft and then click the CLICK HERE to Launch Plan Builder button to go to the Treatment Plan Builder portion of the form. If you have added any new problems, you will see these on this page. You will also see the previous goals, objectives and interventions from the prior version of the plan. Add New Goal(s), Objective(s), and/or Intervention(s) to Your Update IT IS VERY IMPORTANT TO CLICK ON THE PROBLEM, GOAL, OBJECTIVE ASSOCIATED WITH THE ITEM YOU WANT TO ADD, SO THEY ARE CONNECTED TO EACH OTHER. 209 P a g e

210 In the example below, to add a new Objective to the Goal, "Increased mood regulation, click on the text of the goal so that it is highlighted in green. The goal you want to add the objective to must be highlighted like this so that the objective is connected to the goal. Remove and Resolve Problems, Goals, Objectives and Interventions That Are Not Needed To Delete Goals Objectives and Interventions: You must do this from the "bottom up. First, click on one of the interventions you no longer need. When you do this, you will notice that the button, Delete Selected Item is enabled. Click this button to delete the intervention. After you have finished deleting the interventions, delete the objectives, then the goals, then the problems. 210 P a g e

211 To Resolve Any Problems That Are No Longer In Use First, delete them on the Plan Builder Page. Note that even though you delete problems on the Plan Builder Page, they won t disappear from the Problems Table on the Plan Page. These problems are kept because they show a history of the client's treatment and previous problems that have been addressed. Once you are done updating on the Plan Builder Page, return to the Plan Page by clicking, "Back to Plan Page." Resolve the problem in the Problems Table. Note that Avatar will only let you do this if there are no other goals, etc. attached to this problem. It is still "in use," you will not be up to resolve it. In the Problems Table, in the row that has the problem you want to resolve, click in the status column and change the status to "Resolved." Then, enter the Date Resolved. There is column in the Problems Table where you can add any comments if needed. NEXT 1. Obtain signatures as described in the previous sections. 2. Select Draft or Final and submit your plan. Leave in Draft until you obtain signatures. Then finalize and submit. Don t forget to answer the question, Date Client Was Offered a Copy of the Treatment Plan. If you used a paper printout to obtain signature (s), don t forget to fill in the question, If client has not signed, please explain. If client/guardian did not sign at all, you will also need to fill in this question. How to Correct When You Have Selected the Wrong Problem in a Treatment Plan Unfortunately, in a Treatment Plan, you cannot change a problem after you have selected it and added goals, objectives, and interventions to it. 211 P a g e

212 If you have selected the wrong problem, you will need to add the correct problem (the problem you want), create new blank goals, etc for this problem, and then cut and paste from the existing goals, etc. Note that you won't be able to delete the bad problem if someone else has added goals, objectives or interventions to this item, but you will be able to add your goals, etc. to the problem that you want. Steps: 1. In the Problems Table, either add the new problem that you wish to use, or, if it is already in the table, check the checkbox next to the problem. 2. Open the Plan Builder page by clicking, "CLICK HERE to Launch Plan Builder." You should now see the problem you wish to use added to the plan on the Plan Builder page. 3. Add new/blank goal(s), objective(s) and intervention(s) underneath the new problem. They should match the goals, etc. that you want to move. 4. Copy and paste the goals, etc.you wish to move from underneath the bad problem that you don't want, into the blank goals, etc. that you just created. (NOTE: Right clicking won t work to copy and paste. Use keyboard shortcuts instead. Use [Crtl] + C to copy. Use [Crtl] + V to paste.) 5. Once you are done copying and pasting, delete the items from underneath the "bad" problem. You must do this from the "bottom up. a. First, click on one of the interventions. When you do this, you will notice that the button, Delete Selected Item is enabled. Click this button to delete the intervention. b. After you have finished deleting the interventions, delete the objectives, then the goals in the same manner. c. Finally, delete the problem on the plan builder page. 6. Then, return to the Plan Page and find the bad problem in the problems table. 7. If the problem is a mistake and not appropriate for this client, change the status to Resolved. 8. Write a note in the Comments column explaining what happened. 9. Uncheck the problem to make it stop appearing on the Plan Builder Page. IMPORTANT: DO NOT DELETE GOALS, OBJECTIVES OR INTERVENTIONS THAT ARE BEING USED BY OTHER PEOPLE. ONLY DELETE YOUR OWN ITEMS. If you have questions, contact askqi@santacruzcounty.us 212 P a g e

213 Creating an Annual Treatment Plan This describes how to create an Annual treatment plan for your client. You may finalize and submit your Annual plan up to 28 days prior to the due date, which is one day before the Authorization End Date of the last plan. It is recommended that you start working on your treatment plan well before the due date. If you have added yourself to the Plan Participants Table and entered Y in the notification question, Avatar will send a reminder to your My To Do s that the plan is due, 30 days before the due date. The plan will not take effect until the Authorization Start Date or anniversary date. You will not be able to add your treatment plan items in a progress note until the day after the Authorization Start Date. Each client only has one Annual Plan per year. If you are doing your annual update for your client and you see that someone else has already started and created the Annual Plan, you will create an Update. There should not be multiple Annual plans. Who does the Annual Plan first? Any provider participating in a shared plan can create the Annual plan. There is no need to wait for the primary contact or any other person, to start the plan. Steps to Create the Annual Plan: 1. Check the plans in the chart to see if anyone else has started the Annual plan. You should first check to see if anyone else has started the Annual plan. If there is no Annual plan, then you will create it. If someone else has started the Annual plan, but it is still in draft, consider contacting that person to collaborate on it. That way, the client only has to sign once. See the section titled, Signatures for Shared Plans, for more information. If someone else has already created the Annual plan, and this plan has the client signature and is finalized, then you will create an Update. The client only has one Annual plan each year. 2. Open a new Treatment Plan form from the client's chart by clicking, Add in the Treatment Plan inquiry view. a. Open the client's chart if you have not already done so. b. Click SC MH Episodic Treatment Plan in the list of forms on the left in the Chart Overview. c. Click on the tab for your current LE Episode. d. Click Add in the upper right-hand corner of the screen to open a new form. 213 P a g e

214 e. Click Yes when you see the pop up asking if you want to, "default plan information from a previously entered plan. f. Default From Previous: Select the most recent shared plan. g. Enter Authorization Start Date: This is the anniversary date as set by your LE opening date. 214 P a g e

215 h. You will get a warning that you are entering a future date. This is OK. You may finalize and submit an Annual plan up to 28 days prior to the anniversary date. Additionally, it is good practice to begin the plan well in advance of the deadline to allow time for coordination with other providers, editing, and obtaining needed signatures. Click OK. i. You will see another popup asking if you are sure you want to default information from a previous plan. Click Yes. The new plan will open. 215 P a g e

216 3. Enter the Plan Name: In this case, you are creating the Annual plan for your client. The plan title will have the same month and day of the previous plan(s), just one year later. Example If the Initial Plan was titled: 04/05/17 04/04/18 Initial Your Annual Plan will be titled: 04/05/18 04/04/19 Annual Example If last year s Annual Plan was titled: 08/02/17 08/01/18 Annual This year s Annual Plan will be titled: 08/02/18 08/01/19 Annual 4. In the Plan Type field, you will select Annual. 216 P a g e

217 5. Check to make sure that the Authorization End Date is Correct. It should be one year minus one from the Authorization Start Date. Change the Authorization End Date is needed. 6. As with previous plans, adjust the plan data as needed, removing and adding problems, goals, objectives and interventions. Add new plan participants if needed. Remove participants that no longer apply. Edit the Strengths and Challenges as needed. NEXT 1. Obtain signatures as described in the previous sections. 2. Select Draft or Final and submit your plan. Leave in Draft until you obtain signatures. Then finalize and submit. Don t forget to answer the question, Date Client Was Offered a Copy of the Treatment Plan. If you used a paper printout to obtain signature (s), don t forget to fill in the question, If client has not signed, please explain. If client/guardian did not sign at all, you will also need to fill in this question. Collaborating to Obtain Signatures for Shared Plans Clinicians from different teams can collaborate to create one draft version of a shared treatment plan, so that it is only necessary to obtain client/guardian(s) signatures one time. Note that this procedure is OPTIONAL. 217 P a g e

218 EXAMPLE: You are a case manager. Your client also gets services from a therapist at your agency. You and the therapist have a conversation and agree to work together on the Annual plan. You each add to the same draft version of the treatment plan. You agree that the therapist, who meets with the client more often, will obtain the signature. Once you both add your goals, etc to the plan, the therapist obtains the signature and finalizes the plan, routing the document to the various supervisors involved. The document is also routed to you, so you can add your signature. Note though that even if someone else agrees to meet with the client and get the signature, you are still ultimately responsible for making sure that your items in the plan are covered. You should check the chart to make sure that the client signature is there and to make sure that an LPHA has signed the plan. Document Routing Refresher Once a treatment plan has been finalized, a picture of the document is launched for proofreading. Clicking Accept and Route, accepts the document as final (once you enter your password) and launches a screen where you can designate who the treatment plan will be routed to for co-signatures. 218 P a g e

219 How Do Supervisors and Approvers Work in Document Routing? In Avatar, you can route a document to more than one person. The document goes to the Supervisor first. When the Supervisor signs the document, it then goes to any Approvers. There can only be one Supervisor. There can be multiple Approvers. 219 P a g e

220 STEPS (Procedure) 1. Clinicians communicate about the plan, decide to work on the same version of the plan, and decide which person is going to obtain the authorizing client/guardian signature(s). 2. Clinicians add their goals, etc to a single draft copy of the plan. 3. One clinician obtains the client/guardian signature(s) and finalizes the plan. 4. This clinician who finalizes the plan routes the plan to all supervisors and clinicians who need to sign or review the plan. This clinician s own supervisor is designated as the Supervisor for document routing purposes. Others are added as Approvers. Questions It is OK if someone else finalizes and submits the plan? Yes. Your items in the plan are easily identifiable because your name can be seen underneath each goal, objective and intervention you have added. The person finalizing the plan also routes the document to you as an approver, so you will sign this way. It is OK if someone else s supervisor co-signs the plan? Yes, as long as an LPHA has signed or co-signed the plan, the plan is valid. Also, the document should be routed to your supervisor as another approver. I am a supervisor. Is it OK that I am co-signing a plan that has workers from another program adding to it? Yes. Although the plan authorizes services, each team is ultimately responsible for their own service provision. Additionally, using the procedure described above, all supervisors should get an opportunity to look over the plan. If you have concerns about an item added by another team, contact the supervisor. How Many Goals, Objectives and Interventions Should I Add in a Shared Plan? 1) Goals and Objectives: For most plans, there must be AT LEAST two goals and two objectives, TOTAL. For some programs that provide more targeted services, such as housing support, only one goal and objective may be acceptable. See your supervisor if you are not sure. 2) Interventions: You must have an intervention for every type of planned service you provide. Planned services are everything EXCLUDING, crisis, assessment and plan development. (TIP: You need an intervention for every type of billable service code you use, other than crisis, assessment or plan development.) Example: A case manager would typically add an intervention for case management, 220 P a g e

221 rehab and collateral non-family, since these are typical services provided by case management. For those who work with children, you would also typically add an intervention for collateral with family. Those who work with adults may or may not add collateral with family depending on the client. If you are working with a client, you should at least add an intervention to a shared plan. If you don't, it creates the impression that you are duplicating services. Your intervention needs to show that you are doing something different from other teams/providers. 3) Problems: It is OK to only have one problem, although you may have more. If you have more than one problem, you may have only one goal and objective for each problem. It is the TOTAL NUMBER of goals and objectives that s important. 4) If others have already added to a plan, you might only need to add an intervention, or possibly an objective and an intervention. Check and see if the problems, goals and objectives work for you. If so, add what you need for the treatment plan to make sense for the treatment you provide. Example: You look at a plan and find a problem and attached goal that are appropriate for your treatment. You add an objective and intervention to this goal. When Are Treatment Plans Due? You must complete the Initial Treatment Plan before any planned services commence. Planned services are anything other than Assessment, Plan Development and Crisis services. Planned services are things like case management, rehab and therapy. Even though Medi-Cal says that we have up to 60 days from the day we open the client to complete our plans, we can t bill for any planned services until the plan is complete. If the plan is not done, you can only bill for Assessment, Plan Development and Crisis services. Anything else, like case management, therapy or rehab can't happen until the plan is done. Annual plans may be finalized and submitted up to 28 days before the due date, but the plan won't take effect until the Authorization Start Date. This is because Medi-Cal says that treatment plans can only last for a year. 221 P a g e

222 How to Add Your Service Program Information to an Intervention (OPTIONAL) This is an OPTIONAL step to add helpful program information to your interventions. This helps in two ways. First, if you share a plan with other providers, it makes it easier to ID your own interventions when bringing Treatment Plan Information into your progress notes. Second, it helps when others look at the plan and want to know who else has added to it. Add your Service Program information, in parentheses, at the beginning of the intervention. You want to add it at the beginning because goals, etc can get cut off at the end when viewing treatment plan information in the progress notes. Use the mnemonic associated with your program, that is, the short set of letters that serves as an abbreviation for your service program. Examples: If you don t know what your service program abbreviation is, you can find it in any note you have written where the Service Program is listed. 222 P a g e

223 In this example at right, you can see the Service Program information in a progress note in the Progress Note Widget. In this example at right, you can see the Service Program information in a progress note in the chart Inquiry View. Discharging Clients Your first step is to complete a Progress Note OR complete a Treatment/Discharge Summary. You do not have to do both. 1. Complete a Final SC General Purpose Progress Note if billable services are provided in the final contact with the client. If you have a final session/meeting with the client where you provide billable services, you will want to complete a final progress note to document, as well as create a service charge for, the service. Include the discharge date in the note. You can only bill if you have 223 P a g e

224 an interaction with the client on the date of closing that meets documentation criteria for Medi-Cal Specialty MH Services. 2. Complete the Treatment/Discharge Summary form if your last note/contact is not billable (e.g. client drops out and you don t have a last session). The Treatment/Discharge Summary form is a non-billable note where you can provide information about the course of treatment, reasons for discharge, client response to treatment, etc... Use this when the client drops out or for some other reason, you do not have a final session. Note that there are questions and sections on the form that may not apply to your workflow. (This form is designed to document hospital discharges.) Consult with your supervisor on how to best fill out this form. (TIP: The Treatment/Discharge Summary form is one of the few forms that you can complete when the episode is closed.) 3. Send a message to county data entry (Sylvia Vairo) to have the client removed from your caseload. 4. Check to see if your client is open to other services within your Admission Program. For example, for County Mental Health (LE Mental Health Outpatient), check to see if the client has a therapist, a psychiatrist, a case manager, or any other provider associated with the Admission Program. If other people are still working with the client, then you will not close the episode. If you are the only person working with the client, that is, the client has discharged from all services in your LE, then you will complete the Discharge Form. 5. Send a message to anyone else who is working with the client to notify them that you are closing services. 6. If the client is discharging completely from all services within your Admission Program, send a message to your supervisor that the Discharge form is necessary. ONLY DO THIS IF YOU ARE THE LAST PROVIDER TO CLOSE THE CLIENT FOR YOUR ADMISSION PROGRAM. You will prevent other people from writing notes if the client is still getting services. If the client is still getting other services under your Admission Program, the discharge form is not necessary. For most episodes (e.g. LE MH County Outpatient), you will use the Discharge form. For the County Pre Admit Admission Program, you will use the Pre Admit Discharge form, not the regular Discharge form. 7. Before closing the program, check to see if there are any outstanding draft notes. Notes left in draft cannot be completed if the program is closed. Consult with your supervisor about what to do if there are draft notes that haven t been completed yet by someone other than yourself. The easy way to look for draft notes is in the chart. Open the chart and click on one of the links to view notes, e.g. SC General Purpose Progress Note. Click on your Admission Program. Use the sort/filter button that says Draft/Final to filter any draft notes. 8. If the client has been attending groups remove the client from the Group Registration. No shows (M400/A400) associated with groups will prevent the episode from being closed. Any type of note or service, even if it is non-billable, will prevent closing. 224 P a g e

225 Corrections: What To Do If You Make a Mistake I ve made a terrible mistake. IMPORTANT: If you send confidential information, you need to encrypt or send via Avatar Staff Messaging. If you need an encrypted message so that you can send secure information back, send a message to askqi@santacuzcounty.us with subject line, Send encrypted message, and someone will reply with an encrypted message you can use to communicate confidential client information. Corrections Definitions Here is some information about the questions in the templates below to help you fill them out. 225 P a g e

226 Episode (Admission Program) Number Santa Cruz Avatar For deletions and corrections, we need the episode (admission program) number, not just the name of the program. To find it, look at the program tab in the client chart where your document is, or look at the Client Episode Widget. There will be a number before the program name. This is the number we need. Example of the Episode Number in a Program Tab a Chart Example of the Episode Number in the Episode Widget Client Number This is the client s Medical Record Number. Service Date This is the date on which you provided the service we are deleting or correcting. If you make a mistake with the date, we need the date you actually entered, the date that was a mistake. We do not need the date that you wanted it to be. This does not help us. We need this information to find the note so we can delete it. 226 P a g e

227 Data Entry Date This is the date you finalized the form. This is not the Service Date. Find this in the chart inquiry view, in the separator bar at the top of each document. Data Entry Time This is the exact time when you finalized the note or the document. We don't need this all the time, but sometimes this might be the only thing we can use to figure out which note you want us to correct or delete. If you make a mistake, and then redo the note, we usually need this information. Total Duration Time This is the total amount of time spent. We do not need the separate Face-To-Face or Other Time. We only need the Total Duration. Is the episode still open (Y/N): If we are reverting a progress note or other document to draft, we need to know if the episode is closed. If the episode is closed, then we have to reopen it for you. You cannot complete a draft note, or most other documents, in a closed episode. Once you make your changes, you will have to use the Discharge form again to close the episode. 227 P a g e

228 Reason (for deleting note or making changes) Santa Cruz Avatar Medi-Cal requires that we enter a reason when documents are deleted or reverted to draft. Don't forget to provide this information. Is this a group note? (Y/N) We need to know if you are asking for changes or deletion of a group progress note. 228 P a g e

229 Individual Progress Note Corrections Santa Cruz Avatar Use the procedure below to have SC General Purpose Progress Notes and SC Med Service Progress Notes deleted or reverted to draft. There is a different procedure for deleting Group Progress Notes which you can find in the next section. Send your correction message to askqi@santacruzcounty.us Draft progress notes cannot be deleted by the help desk. Only the clinician who wrote the draft note can delete it. See the section, How to Delete a Draft Progress Note, for more information. (See the next section on how to deal with draft group progress notes. They cannot be deleted this way.) If the client name or date is wrong, we will need to delete the note and you will rewrite it. The name or date cannot be changed once the note has been submitted. For other changes, the note can be reverted to draft for you to correct and re-submit. Notes reverted to draft will appear in your My To Do s. Use the template below to provide information about the note(s). If you are re-entering your note, and not just having it deleted, copy and paste the information from your note into a Word document. That way you can paste it back in to Avatar when you re-create your note. Progress Note Deletion and Revert to Draft Template (fill out completely) Client number: Client name: Service Date: Data Entry Date: Data Entry Time*: Total Duration time: Service code: Episode number: Is the episode still open (Y/N): Clinician s name and user number: Action requested (deletion, revert to draft): Reason: Is this a group note? (Y/N): N *If note is same-day duplicate, we might need the data entry time to distinguish your note from others that were written for that client on the same day. If yours is the only note, then we don t need this information. 229 P a g e