Fillable PROGRESS NOTE MH 515 Revised 02/06/08 Other Activity (County of Los Angeles / Internal Services Department)

Fill Online, Printable, Fillable, Blank PROGRESS NOTE MH 515 Revised 02/06/08 Other Activity (County of Los Angeles / Internal Services Department) Form

Use Fill to complete blank online COUNTY OF LOS ANGELES / INTERNAL SERVICES DEPARTMENT (CA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

PROGRESS NOTE MH 515 Revised 02/06/08 Other Activity (County of Los Angeles / Internal Services Department)

On average this form takes 5 minutes to complete

The PROGRESS NOTE MH 515 Revised 02/06/08 Other Activity (County of Los Angeles / Internal Services Department) form is 1 page long and contains:

  • 0 signatures
  • 13 check-boxes
  • 13 other fields

Country of origin: US
File type: PDF

U.S.A. forms for County of Los Angeles / Internal Services Department

BROWSE COUNTY OF LOS ANGELES / INTERNAL SERVICES DEPARTMENT (CA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
PROGRESS NOTE
MH 515
Revised 02/06/08
PROGRESS NOTE
Date: ____________ Telephone Contact: Y N Rendering Provider Face-to-Face/Other Time* (Hrs:Mins): _____________
Procedure Code: _______________ Other Staff Initials: ________ Total Time* (Hrs/Mins): _____________
* All travel and documentation time must be recorded as “Other” or “Total Time” Other Staff Initials: ________ Total Time* (Hrs/Mins): _____________
MHS Activity Type: Assessment Ind Tx Ind Reh Col PsyT Team Conf/CaseCon
GrpTx GrpReh # of Clients Represented: ___________
Other Activity Type
: Cris lnt
TCM
Continued (Sign & complete claim information on last page of note.)
_______________________________________________ _____________ ______________________________________________ ____________
Signature & Discipline Date Co-signature & Discipline Date
This confidential information is provided to you in accord with
State and Federal laws and regulations including but not limited to
applicable Welfare and Institutions Code, Civil Code and HIPAA
Privacy Standards. Duplication of this information for further
disclosure is prohibited without the prior written authorization of
the patient/authorized representative to who it pertains unless
otherwise permitted by law.
Name: IS#:
Agency: Provider #:
Los Angeles County – Department of Mental Health
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

PROGRESS NOTE MH 515 Revised 020608 Other Activity (County of Los Angeles Internal Services Department)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 29 October 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document