Avatar Clinicians Manual - County of Santa Cruz Health Services

Transcription

Santa Cruz Avatar
Avatar Clinicians Manual
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Santa Cruz Avatar Clinicians Manual
Updated: 10/26/16
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Introduction
This manual was written for mental health clinicians and provides basic information on how to
use Avatar documents.
It is continually updated as changes are made to Santa Cruz Avatar. You should check back
periodically for changes and updates.
The manual provides information on how to use Avatar documents. 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 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 Avatar Transition Plans.
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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.
To find information using any search word or phrase, click [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
http://www.santacruzhealth.org/hsahome/hsadivisions/behavioralhealth/avatarresources.aspx
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.
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Table of Contents
Logging In to Avatar ................................................................................................................ 8
Screen Sign Out ....................................................................................................................... 9
To Change Your Current Password ........................................................................................ 9
Java Errors and Problems Logging In ...................................................................................12
Avatar Home View and Menu Bar ..........................................................................................16
Widgets ....................................................................................................................................17
Reports ....................................................................................................................................26
The Master Client Inquiry Report .......................................................................................26
Chart Views .............................................................................................................................27
Chart Overview ....................................................................................................................28
Inquiry View .........................................................................................................................29
Add a Form that is Not Listed to Your Chart View ............................................................32
To Print from the Inquiry View ............................................................................................36
To View Scanned Documents in the Chart ........................................................................36
Staff Messaging ......................................................................................................................38
Pre-Display...........................................................................................................................38
To Retrieve or Open a Message that has been sent to you ..............................................41
Use the To Do List Form to Delete Multiple Items from Your My To Do’s .......................43
Notification Users Form .........................................................................................................44
Multi-Iteration Lists .............................................................................................................45
Caseload Assignment Form ...................................................................................................46
Quick Tips and Shortcuts .......................................................................................................50
Spell Check and Automatic Correction .................................................................................50
Wiki Help and Other Resources .............................................................................................53
Scheduling Calendar ..............................................................................................................54
Scheduling an Appointment in the Scheduling Calendar: ............................................54
Finding an Existing Appointment in the Scheduling Calendar:....................................60
Progress Notes .......................................................................................................................61
Opening a new progress note ............................................................................................61
Writing a new progress note ..............................................................................................63
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Print a Copy of a Progress Note .........................................................................................71
Writing a progress note to document your service for an Assessment or Treatment
Plan ......................................................................................................................................72
Reopening a Draft Progress Note ......................................................................................74
Deleting a Draft Progress Note ...........................................................................................77
Using the Append Progress Notes Form to Add to a Progress Note ..............................79
Indirect (MAA) Service Note ...............................................................................................82
Understanding Client Admissions and Workflow Through the System ..............................83
Client Registration & Financial Program of Admission ....................................................85
County – Pre Admit Outpatient Program of Admission ....................................................85
Service Request and Disposition Log (SRADL): ...............................................................86
Admission Form......................................................................................................................87
Search for the Client ...........................................................................................................87
CLIENT REGISTRATION & FINANCIAL Program of Admission .......................................91
CSI Admission and Cal-OMS Admission ...............................................................................94
Wait List Management ............................................................................................................95
List Detail Section .................................................................................................................100
Overview ............................................................................................................................100
Steps ..................................................................................................................................100
Wait List Management Report ..............................................................................................101
Onset of Services form (Consents) .....................................................................................102
How This Document Works ..............................................................................................102
Consent for the Exchange of Confidential Mental Health and Substance Use Disorder
Treatment Information tab ................................................................................................103
Consent for Mental Health Treatment tab ........................................................................107
Notice of Privacy Practices (HIPPA form) ........................................................................107
Medicare Payment Authorization .....................................................................................108
Private Insurance Authorization .......................................................................................108
Guide to Medi-Cal Mental Health Services.......................................................................108
Disposition and Print Language .......................................................................................108
Assessments: General Concepts ........................................................................................109
Psychosocial Assessment General Concepts ....................................................................111
Santa Cruz Psychosocial Assessment Form ......................................................................113
Presenting Problem Tab ................................................................................................114
Culture/Spirituality Tab ..................................................................................................115
Mental Health Hx Tab .....................................................................................................115
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Risk Factors Tab ............................................................................................................116
Legal History Tab ...........................................................................................................116
Medical Information Tab ................................................................................................116
Client resources form ....................................................................................................116
Developmental History Tab ...........................................................................................117
CRAFFT/CAGE AID Tab .................................................................................................117
CRAAFT section (for children/youth) ...........................................................................117
CAGE AID section (for adults) ......................................................................................118
Substance List Tab ........................................................................................................118
Substance Use Hx Tab ......................................................................................................119
Trauma History Tab .......................................................................................................119
Strengths Tab .................................................................................................................119
Summary Tab .................................................................................................................120
Finalizing and Submitting the Psychosocial ...................................................................123
How to Reopen a Draft Psychosocial Assessment Form...................................................123
Open a Draft Psychosocial Assessment from your Home Console ..............................123
Open a Draft Psychosocial Assessment from the Chart ................................................125
How to View a Completed Psychosocial Assessment in the Chart ...................................126
How to Print a Psychosocial Assessment Form .................................................................127
Assessment Updates ............................................................................................................128
Risk Assessment Form ........................................................................................................128
Mental Status Exam (MSE) Form .........................................................................................128
ASAM Form ...........................................................................................................................129
ASI Form ................................................................................................................................129
CANS/ANSA Form .................................................................................................................129
To Print a Copy of Your CANS/ANSA...............................................................................134
Admission Diagnosis............................................................................................................135
When to complete the Diagnosis form .............................................................................135
To View a Client’s Current Diagnosis ..............................................................................136
Diagnosis Update ..................................................................................................................140
To Resolve a Diagnosis ....................................................................................................142
The Santa Cruz County Integrated Treatment Plan ............................................................144
Treatment Plan Overview .....................................................................................................145
Integrated Treatment Planning and Due Dates................................................................145
Treatment Plans for Monolingual Clients ........................................................................146
Creating an Initial Treatment Plan .......................................................................................146
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How to Add Your Service Program Information to an Intervention (OPTIONAL) ..........157
Printing a Copy of Your Treatment Plan ..........................................................................159
Printed Treatment Plan Workflows (what to do if you don’t have a signature pad)......162
Creating a Treatment Plan Update for New Services .........................................................164
Creating a Treatment Plan Update for Updating Problems, Goals, Objectives and
Interventions .........................................................................................................................169
How to Resolve Goals, Objectives, and Interventions ....................................................173
How to Resolve Problems.................................................................................................174
Creating an Annual Plan .......................................................................................................174
Who does the Annual Plan first?......................................................................................174
Discharging Clients ..............................................................................................................178
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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 UAT, it is https://santacruzuat.netsmartcloud.com/radplus/index.jsp.
For the LIVE, it is https://santacruz.netsmartcloud.com/radplus/index.jsp.
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.
4) To log in:
a. Enter your System Code (all caps). For example,
UATEN or LIVEMH. Note that your system code is
determined by your agency and your role. The
system code is different for different users.
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 help desk if you think you may have a
different log in name.)
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c. Enter your Password (case sensitive). Typically, your password=your log in name if you
are a first time user.
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.
e. Once you have entered your Username and Password, Click Sign In.
f.
If you forget your password:
i. After five tries, Avatar will deactivate your user account and you will no longer
be able to log in, even with your correct password.
ii. 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.
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). When signing back into Avatar, type UAT or LIVE in the
system code and then enter your user name and password.
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.
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2) Click in the Search Forms field and type Change Current Password. Double click on the form
name to open up the form.
3)
4)
5)
6)
Once you have opened up the form, in the Current Password field, enter your current password.
In the New Password field, enter your new password.
In the Re-Enter New Password field, enter your new password again.
On the left hand side of the screen, click on the Submit Button.
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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
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Java Errors and Problems Logging In
1) If you see the warning below, your Java is not set up. For help with this problem, contact the
helpdesk at x4657 or hsamhhelp@co.santa-cruz.ca.us
2) If you see the message below, click Allow.
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3) If you receive the popup below, click Save and then click Open.
a. If Avatar is telling that you need to update Java (seen usually at the login screen), you
can make these messages disappear by:
i. Going to the Avatar UAT login screen.
ii. The go to Tools → Internet Options
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b. Click on the Security Tab → Trusted Sites → Click on Sites
c. You should see the Avatar address in the window that appears (shown below). Click on
Add, then click Close.
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If none of these steps help or if you need further assistance, contact the helpdesk at x4657 or
hsamhhelp@co.santa-cruz.ca.us
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Avatar Home View and Menu Bar
1) 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.)
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5) Menu Bar: The Menu Bar, located at the top of the Avatar screen, is an important feature. It
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.
6) 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).
7) Roles: A role is essentially a job category in Avatar. Examples of roles are Clinician,
ContractAdminSupport, Prescriber. Your Avatar Role determines which console or consoles to
which you have access. Your role also determines what forms you can work with, what you can
view, which charts you can view, scheduling and many other functions.
Widgets
1) Widgets: These 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.
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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.
2) 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.)
a. If you have made changes to the layout of your widgets and want to return to the
default layout, on the right side of the menu bar, reset your widgets to your default
layout by clicking on the box icon shown.
b. Click Reload Home View and then Apply to restore the widgets to their default layout.
c. The Refresh Button: Many widgets have 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.
3) Forms & Data Widget: This Widget allows you to access forms in Avatar. There are several ways
to search for forms using this Widget.
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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 a form is not already in the My
Forms section of the Widget, and you have recently
opened that form, it will appear in Recent Forms.
However, if the form is already in the My Forms area,
it will not 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.
a. Adding Forms to My Forms: There are two ways to add a form to your My Forms list.
i. You can click and drag a form from Recent Forms up to the My Forms section.
ii. Or you can click on Edit, located in the upper right of the widget.
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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.
4) My Clients Widget: This Widget functions similarly to the Forms & Data Widget, with sections
and links allowing different types of searches.
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My Clients:
The clients assigned to you are marked
with an arrow symbol, >. Your caseload is
here.
You may also temporarily add clients
here (see below). These clients do not
have an arrow next to them.
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.
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a. 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. Note that 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 similar search box.
5) The My To Do’s Widget: 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 in order for the item to go away. See the section on Staff Messaging for
more information.
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6) My Calendar Widget
a. 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.
b. 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.
c. 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.
7) 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
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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 will be covered more in the Access class.
8) 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). Note that a client must have already had some services, or
the widget will be blank.
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9) Progress Note Widget: This widget shows all of a selected client’s progress notes.
In the chart, notes can be sorted and filtered in a variety of ways, the Widget compiles all notes
from all mental health programs into one place.
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 Tab. 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.
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Reports
Reports are another way to see information from Avatar. They are different from Widgets in that their
information is static. However, Reports can be created daily or even more often if needed. 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.
The Master Client Inquiry Report
This is similar to a Face Sheet. You can access this report by going to My Forms, searching for
Master Client Inquiry Report and double clicking it from the results. This opens a select Client
window. Type in your Client’s name and then double click it in the results to get the report.
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Chart Views
To open a chart, first you must 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.
At the top of your screen, notice your links to any 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.
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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.
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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 which
contains the last several
months of data, including draft
versions. 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).
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Program Tabs: In Inquiry View, you will see a set of tabs across the top of the Inquiry View. Each tab
represents a different Program of Admission. Make sure you click on the correct Program of Admission
(POA) when viewing documents. Similarly, when you open up a new form in the client's chart, make
sure you have the correct POA tab. If you have clicked on the wrong POA, the document will be misfiled.
If the client has several programs in the chart, you won't be able to see all of the tabs. Click on the very
tiny triangles at the upper right to scroll back and forth among the chart tabs.
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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.
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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.
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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.”
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Click on “Diagnosis” to view diagnoses that have been added to the chart.
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To Print from the Inquiry View
Many forms can be printed directly
from the inquiry view. Note that some
forms have a formatted report that
you may prefer instead of printing
from the inquiry view. The
Psychosocial and the Treatment Plan
both have formatted reports.
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 described above to adjust the view
before printing. 85% gives you a
printout with font size that is about 10
or 11 points.
To View Scanned Documents in the Chart
At the bottom of the list of documents on the left, you
may see section titled “Documents” where you can find a
link to scanned documents. If there are no scanned
documents for your client, this section will not be visible at
all. If you do not see it, you will know that there are no
scanned documents in the chart.
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Sort and Filter Buttons: At the top of the Inquiry View, underneath the program tabs, you will see bars
or buttons that allow you to sort and filter documents in a variety of ways.
To Open a Form from Inquiry View: You must open a form in order to enter data. Once you have
opened the Inquiry View for the form you want, for example SC General Purpose Progress note, you will
see a small "Add" in the upper right-hand corner. Click Add to open a new progress note for the client.
IMPORTANT: Make sure you have clicked on the correct tab for your Program Of Admission, for
example LE – 00044 County Outpatient. Otherwise, your note will be filed incorrectly and people may
not be able to find it. You also may not be able to complete the note.
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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. A pre-display
shows you all the 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.
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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. Note that you may send a single message to multiple recipients. Note that this
doesn’t work like e-mail in that multiple recipients cannot see each other in the
message. Essentially, when you send a message to multiple recipients, you are “blind
copying” all of them.
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If your Send Notification To field looks
blank, this means that your
Notification Users has not yet been set
up. See the section on the Notification
Users form to see how to do this.
Required items: Note that 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.
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.
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To Retrieve or Open a Message that has been sent to you
You will 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.
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3) Read you 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 USE THIS METHOD TO OPEN ANY FORMS OTHER THAN MESSAGES. For
all other forms, click on the name of the form to open the form to complete it. If you use the
above method, you will not open the form you need and you will start down a path do delete
the reminder you need for a form that needs completing. For some forms, like progress notes,
there is no other way to open drafts. You cannot open a draft progress note from the chart.
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Use the To Do List Form to Delete Multiple Items from Your My To Do’s
This feature is helpful if someone’s My To Do’s becomes too full. For
example, after a vacation or leave. To rapidly go through the list and
delete what is not needed, run the report, To Do List. This can be
found by typing “To Do List” in the Search Forms field in your Forms &
Data Widget.
Once the first screen is opened, click “To Do
List Maintenance” to run the report.
You will now see a list
of every item in your
My To Do’s. You may
select items by
checking them off on
the left and then
clicking "Remove Sel
Rows” in the lower
left-hand corner.
Click "Enable Col
Resize" to see more of
the information in the
columns. If you want
even more
information about a
specific item, click on
that row, and then click "Display Row Detail."
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Notification Users Form
If your Send Notification To field looks blank, this
means that your Notification Users has not yet been
set up. Use the Notification Users Form to add people
to whom you can send message.
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.
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.
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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.
Multi-Iteration Lists
In Avatar, you will sometimes see a table like the one in the Notification Users form. These
tables or multi-iteration lists are for adding sets of information to Avatar. When you see a table
like this, know that you will always have to add a new blank row before you can begin entering
data.
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Exercise:
1. Send a message to one or more users.
2. If you don’t have any messages, ask someone to send one to you and then view the message that
was sent to you in your My To Do’s Widget.
3. Before clearing the item, you will want to read the message attached to the referral by clicking
Review To Do Item.
Caseload Assignment Form
As of July, 2016,
this 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.
Include your
Program of
Service in the
message.
1) Search for the Caseload Assignment form in your My Forms Widget in your Home Console.
Then Select the Caseload Assignment form by double clicking on the form name in the search
results.
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2) A Select Client box will appear on the screen. In the search field, type in the name of the Client
that you want to assign or remove from a caseload and then click enter. For this search, you can
use either the first name or the last name of the client and Avatar will search dynamically for the
name.
3) The Clients who are
similar matches will
appear in the large
search results box.
You can either double
click on the Client you
want or click on the
Client’s name then
click Select.
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4) If the Client is not
currently in your caseload,
you will see the NonCaseload Access message
appear. Click on Yes.
5) You must now enter a
reason for accessing the
case. In this example, we
used the reason “assigning
case to staff”. Once you have
entered your reason, click
OK.
6) You will see another NonCaseload Access message
appear. This notifies you
that your access date, time
and reason have been
recorded. Click OK. [Note
that for some staff, this
auditing function has been
turned off. However, Avatar
always records everything
that you do. When you access records, make sure you have a legitimate reason for doing so. Just
because you can see something, doesn’t mean you should see something.]
You may see a Pre-Display if the Client has previously been assigned to other staff, otherwise,
you will go straight to the form.
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7) Specify the action
you wish to take,
either adding or
removing the client
from your
caseload.
8) Search for the
Practitioner you
wish to assign the
Client (search for
the Practitioner by
last name), the
Program of Service
and the Type of
Assignment.
9) Click on Submit.
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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.
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.
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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.
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.
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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.
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Wiki Help and Other Resources
Online documentation may be available for some forms. If it is
available, there will be a link on the left side of the form.
Clicking on Help in the upper right of your home screen goes to general help resources.
Visit the Training Folder for available materials at I:\Shared\Training Materials/MyAvatar.
Other help:
1.
2.
3.
4.
County Trainings (watch for e-mails and the Avatar Bulletin for more information)
QI email (AskQI@santacruzcounty.us) and Supervisors
Written documentation posted on the County Avatar website
http://www.santacruzhealth.org/hsahome/hsadivisions/behavioralhealth/avatarresources.aspx
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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.
Scheduling Calendar
The Avatar Scheduling Calendar gives the user the ability to manage appointments at multiple sites for
staff members, clients, and groups. In the Scheduling Calendar, you can create appointments, check
clients in and out for their appointments, launch progress notes and more. You can also assign multiple
practitioners to an appointment (e.g. groups). Progress notes may be opened and written directly from
the Scheduling Calendar with all of the information from the appointment auto populated into the form.
When to use your calendar: County Mental Health staff must use the calendar for all services provided,
however, Avatar will not stop you from writing a progress note without an appointment. However, you
are strongly encouraged to do so because of the benefits it provides.
Scheduling an Appointment in the Scheduling Calendar:
Use this tutorial to practice scheduling an appointment in your calendar.
1.
You are going to add a new appointment on today’s date for your calendar. Open up the
Scheduling Calendar under My Forms, in the Forms & Data widget on the Home View.
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2.
The Scheduling Calendar allows you to view appointments for one day, one week, or one month.
Click on the “Week” view.
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.
4. 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.
3.
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5.
Right Click on the calendar at the desired appointment time and then click “Add Appointment.”
6.
The Add New Appointment form will open.
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Program: This is the Program of Service under which you provide services, e.g. County – Adult
Recovery, Encompass – Child Enhanced Sup Svcs, County – Child School. (The Program of
Admission is noted in the “Episode” field.)
8. Location Code: For most programs, the Location code should auto-populate to “Office.” Change
if needed.
7.
9.
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 you can add to the
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appointment without knowing the Service Program. (E.g. only psychiatry can provide medication
services.)
10. 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.
11. Enter CO-PRACTITIONER(S) if applicable.
12. 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. Selecting No End schedules the recurring appointments for a year.
v. Note that you may go back and delete all or part of a series at a later time. To
adjust a series, return to your Scheduling Calendar. Then, Right click on one of
the appointments in the series. Telect “Delete.” A list of all appointments in the
series will pop up. You can then select which ones you want to delete. (If you
want to delete all or most of the remaining appointments in the series,
remember that pressing CRTL + A on your keyboard will select all of the check
boxes in a list.)
vi. To schedule an appointment every other week, enter “Other” under
Recurrence Schedule and then “14” in the blank for Days.
13. Click the Submit button on the left side of the screen to save your appointment and return to the
Scheduling Calendar.
14. Notice that the new appointment is now listed on the Calendar
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15. At this point you can right click within the appointment to see additional options.
16. 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.
17. 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.
18. When you are finished with the calendar, click on Dismiss and the bottom of the form.
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19. Scheduling Calendar vs. the My Calendar Widget:
(a) 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.
(b) 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 some clerical roles, you will not have access to other staff members
calendars. However, you can 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 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 appointments in the calendar that have not yet been
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scheduled with an actual client. Below you can see the next 10 open appointments for
Medication Management. They have all been scheduled with the “client” RESERVED TIME.
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.
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1. From the My Calendar Widget
2. 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.)
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All of the above methods will open up the note for preselected client, and 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.
Writing a new progress note
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IMPORTANT: You must enter information and click items in order, or the form may not function
correctly.
1. Select Client: Once you have opened the SC General Purpose Progress Note form, add the
client’s name in the Select Client field, if the client was not preselected from an appointment.
2. Select Episode (Program of Admission):
a. In the Drop-down list, select which Program of Admission is associated with the
note/service, e.g. LE00044 MH COUNTY OUTPATIENT or County ADP Prevention HSA. (If
the Program was not already entered from an appointment.)
b. IMPORTANT: Make sure you select the correct episode or your note. Your note will be
misfiled under the wrong program if you make an error and are able to finalize it.
Typically though, the note will not work correctly and you will not be able to finalize and
submit it. 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 for the client will pop up in the menu
below, "Note Addresses Which Existing Service/Appointment."
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
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is the time spent in direct contact with the client. Other Time is all other time associated with
the appointment including writing notes and travel time.
You should consult with your supervisor about which services are allowable for “Other Time”
under your Program of Service.
6. Service Information: Note that the field for Service Charge Code will provide a list of options
once you begin typing. For example, type "M" for a list of all mental health codes.
7.
Evidence Based Practices/Service Strategies: enter the appropriate practices and strategies
based on the requirements of your workflow.
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.
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9.
Treatment Plan Elements section:
a. If there is a treatment plan for the client, you will select which plan elements the service
you provided addresses.
b. Start with the Select Treatment Plan Version menu to select which plan and
goals/objectives you want to use for the note.
c. After selecting the Treatment Plan Version that you want, click Select T.P Item Note
Addresses, which will open a view of the treatment plan. Double click on the item in the
Treatment Plan you want to address in the note. Avatar will add everything above what
you select, up through the associated goal. Typically, you will want to select an
intervention. When you do this, Avatar will also add the associated objective, goal and
problem for that intervention. (See Treatment Plan section for more information.)
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d. After you selected what portions of the treatment plan you want to address in the note,
click Return. You will now see the items you selected in the box labeled Note Addresses
Which Treatment Plan Problem box.
e. 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 you are writing, which will vary depending on what
you clicked in the Progress Note Purpose field.
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a. Write the note in the blanks that are enabled (not greyed out).
b. Special types of notes: some notes, such as the information note or the residential note
may have some blanks in the progress note disabled based on workflow. (IMPORTANT:
If you click Information Note or Residential Note accidentally, some parts of the form
won’t work for a routine progress note.)
c. 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 they
are moving out town and she no longer wants services.
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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 in your To Do items will launch your draft the progress
note for you to complete.
i. In your My To Do’s DO NOT click Review Draft 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.
c. After proofreading, you have three options:
i. Accept: accepts the note as final and files it. You are done at this point.
ii. Reject: rejects the note so that you can return it to draft status for editing (click
“Draft” once you get back to the note).
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iii. Accept and Route: accepts the note and routes it to a supervisor and/or one or
more approvers for a co-signature.
1. To Route to a Supervisor: Enter the supervisor’s name in the blank.
Then click Add. The supervisor’s name will appear in the list at the
bottom of the window.
2. To Route to one or more Approvers: Enter the approvers’ names in the
blank. Then click Add after each approver. The approvers’ names will
appear in the list at the bottom of the window.
3. What is the difference between a Supervisor and an Approver? Avatar
sends the document to the person you have designated as “Supervisor”
first. When that person signs the document, it then goes to the
approver(s). It is only after the “Supervisor” signs, that the document
gets released to the Approvers. Your documents show up in your
supervisor’s and approver(s) My To Do’s. From there, they can sign the
document, or they can return it to you for corrections. If a
supervisor/approver “rejects” a document for corrections, they will not
sign it and it will return to your My To Do’s as a draft. There is an option
for the supervisor/approver to write a short message indicating the
required changes. Once you edit the document, finalize and submit or
file once again and re-route to the supervisor/approvers.
4. To Route to a Team: This will route to all the members of a team, if the
team has been set up in Avatar. Enter the team name in the blank. Then
click Add.
5. Once routing has been set up, click Submit.
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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. However, 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 and the link on the left side of the chart overview for the progress
note type you want, either SC General Purpose Progress Note, SC Med Service Progress
Note or SC Group Service Progress Note.
2. Make sure you click on the correct Admission Program tab at the top of the screen.
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3. This will bring up
a pre display
where you can
select a Progress
Note to print. If
there are a lot of
notes, you can
use the various
Sort/Filter
buttons to narrow
down your note
search.
4. To the 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
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.
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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.
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 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.
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Reopening a Draft Progress Note
If you save your note in draft, the draft note will be sent to your My To Do's. You can open up the draft
notes from there to complete it.
Steps
First, look for the note in your My To Do’s. You can click on the name of the form to open it up. If the
note is not there, you will have to open it up from the chart.
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.
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3. Click on the tab for your Admission Program. In the picture below, the selected admission
program is episode 4: LE - 00044 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.
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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.
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Deleting a Draft Progress Note
If you make an error and your progress note is still in Draft form, you can delete the note yourself. Only
the original author of the draft note can delete the note in this manner. The helpdesk or QA cannot
delete it for you.
(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 the draft note will be sent 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
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 - 00044 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.
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4. Locate the Draft Progress Note you would like to delete and select “Edit”.
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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.
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 using the Append Progress Notes form. Once the Append form has been completed, the added
information will appear as an addendum at the end of the Progress Note in Avatar.
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If you need to void (delete) a note or change the service code contact the QA help desk at at 454-4468
or askQI@santacruzcounty.us. If you need to change the client name (wrong client), or change the time
spent, contact the IT helpdesk.
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.
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.
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 for 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,
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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.)
5. 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.
6. 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.
7. 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.
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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.
Locate the Forms & Data widget on your home view.
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1) Click in the Search Forms field 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) 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.
4) On the left hand side of the screen, click on the Submit Button.
Understanding Client Admissions and Workflow Through the System
1. Avatar has two types of programs, Programs of Admission (POA’s) and Programs of Service
(POS’s). A Program of Admission is a broad admission that covers many services provided in an
agency. A Program of Service is narrower. Service provision (notes, billing) is completed under a
Program of Service (service teams, psychiatry, substance abuse treatment programs, etc…).
Clients are no longer “opened” to Programs of Service (as with prior EMR systems). Once the
appropriate Program of Admission is opened, service delivery commences. The appropriate
Program of Service is noted in the progress notes.
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Program of Admission
County LE - 00044
COUNTY OUTPATIENT
LE - 00439 VOLUNTEER
CENTER EPISODE
Program of Service
County - Adult
Recovery North
Program of Service Vol
Ctr - Community
Connection Adult
Outpatient CalWORKS
Program of Service
County - North
Medical FQHC
Services (Psychiatry)
Program of Service Vol
Ctr - Mariposa Adult
Outpatient
Program of Service
County - North ChildSchool
Program of Service
County - North FQHC
Therapy Services
Etc....
2. This concept is slightly different in Substance Use Disorders (SUD) treatment vs. Behavioral
Health (BH) treatment.
a. In BH treatment, a Program of Admission is a broad “episode” that encompasses the
entire time a client receives services from County BH or an entire contract agency. It can
go on for many years.
b. In SUD treatment, due to different confidentiality regulations, the Program of Admission
is narrower and only specific to the particular treatment facility or program where the
client is getting services.
c. For each Program of Admission, there is only one Program of Service.
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Janus Main - Adult
Residential Detox
Encompass CS - Alto
North Outpatient
ADP Family and
Children Svcs
Program of Service
Janus Main - Adult
Residential Detox
Program of Service
Encompass CS Alto North
Outpatient
Program of Service
ADP Family and
Children Svcs
Client Registration & Financial Program of Admission
Client Registration & Financial is the first Program of Admission for all clients in Avatar. No services are
associated with this Program of Admission. It exists to allow the client to be entered into the system and
assignment of a client number only.
The main takeaway is that the Client Registration & Financial Opening needs to be paired with another
Program Of Admission (e.g. LE00044 MH COUNTY OUTPATIENT or County ADP Prevention HSA) order to
provide billable services.
County – Pre Admit Outpatient Program of Admission
1. This unique Program of Admission allows for limited services 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:
a. Field crisis for a non-open client
b. Jail crisis
c. Crisis residential services
d. Extended assessments for children under five
e. Assessment services when the assessment is provided over a longer period of time, i.e.
more than one visit is needed to determine whether client meets criteria for services
2. Under this Program of Admission, 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
Program of Service.
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Client Reg
& Financial
Pre-Admit
LE - 00044
COUNTY OUTPATIENT
• Client or representative calls or comes in for services,
or a referral is received.
• Client opened to the Client Registration & Financial
Program of Admission.
• Client number assigned.
• Info noted in Service Request and Disposition Log.
• Assessment appointment scheduled.
• No services are billed.
• 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.
• 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, PreAdmit is closed when LE - 00044 County Outpatient is
opened.
Service Request and Disposition Log (SRADL):
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1. Previously called the Access Log or Call Logging
2. 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.
3. Features:
a. There are clerical and clinical sections on the form. The person filling out the clerical
section of the form will file it in "draft" format. The person completing the form
"activates" the clinical section by clicking a radio button and then completes and
finalizes the form.
b. There are Behavioral Health and Substance Use Disorder questions in the SRADL form,
because clinicians from all agencies and contractors will be using the form.
4. 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.)
5. 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.
Admission Form
Search for the Client
To help you understand admissions, you will add a brand new client to Avatar, using the Admission
form. For the purposes of this exercise, you will admit the client to Client Registration & Financial and
then to LE-00044 MH County Outpatient. These are Programs of Admission (POA’s or Admission
Programs).
1. 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.
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2. 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.
3. Type in three pieces of information in order to search for the client. Once 3 pieces of information
are entered, the Search button will activate. (Even if you know you're adding a brand-new client,
Avatar will want you to enter the information and perform the search.)
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4. 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.) For the
purposes of this exercise, you will enter a brand-new client. Even if the name you have selected is
already in Avatar, you will treat this as a new client. However, try to pick a unique name if you can.
5. 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.
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6. Click New Client on the Search Client window to launch the Admission form.
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7. 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
i. Client Name will be auto populated from the Search Client window.
ii. 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.
iii. 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.
iv. 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
entered into Avatar multiple times.
v. Program: For the purposes of this exercise, first open the client to CLIENT
REGISTRATION & FINANCIAL.
CLIENT REGISTRATION & FINANCIAL Program of Admission
Client Registration & Financial is the first Program of Admission for all clients in Avatar. No services are
associated with this Program of Admission. 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.
vi. Type of Admission: Enter First Admission.
vii. 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.
viii. Initial Point of Contact: This is you. Enter your ID here by typing in your last name
and pressing Enter. Typically, this is the first clinical staff person encountering the
client.
ix. 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
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you are practicing in avatar, add your own name. This field will add the client to the
clinician’s My Clients Widget.
x. Skip the following: Practitioner Type, Disposition, Perform Discharge Alert, Type Of
Alert. These items are not used.
b. Presenting Problems/Disabilities tab: Only answer the Disabilities questions in this section.
Skip the Presenting Problems questions and the Current Medications questions. Skip the
remaining tabs and the Compliance Indicators section. Move on to the Demographics tab.
2. Demographics tab: None of these items are “required" for you to Submit the form. However,
complete as many as you can. Client race/ethnicity are required CSI items.
3. Complete a new admission in a different program: You will now complete another admission for
your client. This time, you will open the client to your Program of Admission. For Adult or
Children's Mental Health, the program is LE-00044 MH County Outpatient.
a. Double click on the Admission form from your Forms & Data Widget.
b. 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.
c. You will see a Pre-Display listing all of your client's prior admissions. Since this is a brandnew 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.
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5. Admit the client to your Admission Program or “LE”. For County Mental Health clients, this is LE –
00044 MH County Outpatient.
6. Type of Admission will be First Admission since this is the first admission to your Admission
Program.
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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 completed when the client is initially opened to services, and then annually
by the clinician. Staff providing direct service delivery, such as coordinators and therapists,
complete annual updates.
3. Paper forms are available for situations where there is no access to a computer or where the
client is providing this information directly.
4. 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.
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5. Do your best to answer the
questions on the form. GATHER
AT LEAST: Last Name, First Name,
DOB, SSN, gender.
6. YOU DO NOT HAVE TO ANSWER:
Questions about Problems and
Medications. These are covered
elsewhere in Avatar.
7. Update Client Data form: 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.
8. 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.
Figure 1 Example of CSI Widget with
Missing Information
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.
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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.
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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.
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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.
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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.
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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.
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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.
2.
3.
4.
In the Unit field, select the unit.
In the Date Added Start field, enter the first date that clients were added to this waiting list.
In the Date Added End field, enter the last date that clients were added to this waiting list.
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.
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Onset of Services form (Consents)
How This Document Works
This Avatar form, actually a set of several tabs related to several different types of 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.
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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
3. Notice of Privacy Practices (HIPPA form)
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. However, 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.
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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.
Avatar “Exchange” tab: Once the client has signed the paper consent, fill out the first tab
of the Avatar Onset of Services form.
1. Fill in the Date and Time that the client signed the form.
2. Was the Authorization for Use, exchange and/or Disclosure of Confidential 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.
3. This authorization is being completed by: Enter the person who is authorizing or signing the
document.
4. If applicable, was the Authorization for Use, exchange, and/or Disclosure of Confidential
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.”
5. Notes on interpretation/translation of Authorization for Use, exchange, and/or Disclosure
of Confidential Information: In the this field, you may add any information about
interpretation/translation.
6. Client or representative's preferred language: Enter the preferred language.
7. 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.
8. Relationship to client: If applicable, note the relationship of the person signing the form to
the client. Otherwise, leave blank.
9. Client or representatives signature: If you have a signature pad available, click "Get
Signature" to activate the signature pad. Have the client sign and click "OK” to import the
signature into Avatar.
10. Client's or representative's reason for 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.)
11. Witness (Staff) signature: Do not use this question. Staff sign when finalizing and submitting
document.
12. Staff Name: Enter the name of the staff person filling out this form.
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Consent for Mental Health Treatment tab
1. Was the consent 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 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 or representative's preferred language? Enter the preferred language.
4. Notes on interpretation/translation of consent: In the this field, you may add any information
about interpretation/translation.
5. By signing below, the client or their representative acknowledges understanding the consent
for MH services: Currently (8/19/16) this field for electronic signature is required (red). This
means that you will not be able to finalize the Onset of Services form without electronic
signature. If you do not have a signature pad available, leave this field blank and leave the form
in draft.
6. Date (Client Signature): Like the signature field, this field is required (red). Note the date that
the client signed the Consent to Treat.
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: 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. Staff signature: Do not use this question. Staff sign when finalizing and submitting document.
12. Staff name: Enter the name of the staff person completing the document.
13. Date (Staff signature): Do not use this question. Staff sign when finalizing and submitting
document.
14. Time: Do not use this question.
Notice of Privacy Practices (HIPPA form)
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.
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5. Notice of Privacy Practices Consumer 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: Do not use this question. Staff sign when finalizing
and submitting document.
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.
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.
Enter "Yes" if the client was given a guide in Spanish.
3. Client or Representative's preferred language? Enter the client's language.
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.
Disposition and Print Language
1. The printed Consent will be in: This question is not applicable, since we are not printing a copy
of the entire Onset of Services form. However, the question is required (red). Click the
client's/representative's preferred language. If the language is other than Spanish or English,
leave blank. In this case, you will not be able to finalize the form and will need to leave it in
draft.
2. Draft/Final Status: You must finalize this form before you can submit and sign. At the time of
publication of this document, there are some required (red) questions that may prevent you
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from finalizing the form. If you are unable to finalize the form for this reason, leave the form in
draft.
Assessments: General Concepts
1. Assessments in Avatar are made up of multiple groupings of 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.
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•Risk Assessment
•Diagnosis
•MSE
•Progress Note
CRISIS ASSESSMENT
•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
SHARED FORMS
PSYCHOSOCIAL ASSESSMENT
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•(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 it’s 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.
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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. However, 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.
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Click the triangle to
open up this section
in the Risk Factors
tab.
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. At the time of publication of this document (8/19/16) 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
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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.
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” WHEN YOU
EXIT THE FORM.
Santa Cruz Psychosocial Assessment Form
Open up a new Psychosocial Assessment SC form for your client. Click once on your client (in the My
Clients Widget) to highlight the client, 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 POA under which you provide services, e.g. ME – 00044 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.
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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.
2. In the Type of Assessment field, select the appropriate type of assessment.
3. In the Assessment for what population field, select the appropriate
population.
4. 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.
5. Draft/Final: Next, 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 and return to it at a
later time. Now return to the Presenting Problem Tab.
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6. Complete the Presenting Problem (What made client/child come for services?) and Describe
any functional Impairments fields.
7. 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.
8. Search Function: Click the tiny magnifying glass to search for a word or phrase in
your text.
Culture/Spirituality Tab
Complete data entry for the, “Describe the client’s/child’s cultural practices and spiritual
beliefs,” question and, “Describe the client’s/child’s gender roles and sexuality,” question.
ALTHOUGH NOT RED/REQUIRED, THIS IS A REQUIRED QUESTION BY MEDI-CAL.
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.
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Note that 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.
4. Use F5 button to uncheck a radio button.
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 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. However, you will need to complete the Risk Assessment
form at some point if answered “yes” to any of the trigger questions.
Note that the questions on the form differentiate between current and past suicidal/homicidal
behaviors/ideation. Only current suicidality, homicidality and/or grave disability trigger the full
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 the rest of the questions in the section.
Medical Information Tab
Client resources form
The question regarding primary care provider launches a window to the Client Resources form. THIS
QUESTION IS REQUIRED BY MEDI-CAL. ALTHOUGH NOT RED/REQUIRED IN AVATAR, YOU MUST ANSWER
THIS QUESTION.
The Client Resources form allows support people, family and other providers such as medical doctors to
be entered into Avatar. View client resources in the Client Resources Widget on the Home console.
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Pregnancy and Postpartum Sections: For Janus Perinatal Program only.
Developmental History Tab
Answer these questions as appropriate.
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.)
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CAGE AID section (for adults)
The CAGE AID is either required (adults) or disabled (children).
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.
Substance List Tab
Required for:
1. 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.
The Substance List Tab contains a multi-iteration list. Information about each substance the
client uses/abuses has it’s 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 the information, even if the
substance (e.g. caffeine, suppliments) is used moderately and appropriately.
Even if the client uses no substances at all, you must still complete the tab. In this case,
proceed as if you are going to add a new substance (see below) but check, “None” for
“Substance Type.” Everything else on the form will then be disabled and greyed out, so you will
not have to enter any more data on this tab.
STEPS:
1. Click Add New Item: Begin by adding a new row to the 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.)
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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.
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.
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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.
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: These two fields are either enabled or disabled by the question above them, "Is
client being referred to/re-authorized for services?"
If you click "Yes", the field, "Clinical summary of recommended services..." will be enabled.
If you click "No", the field, "Clinical summary, explain reason for denial…" will be enabled.
If you write your summary, and then change your mind and click the other button, everything
in your summary will be erased.
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.
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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.
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Clinical summary of recommended services: This field is activated if the client is authorized 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 diagnosis is appropriate
for this field, if you wish to do so.
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 Drug Grid (Children’s). Only licensed/waivered/registered staff complete the
Diagnosis form (and the MSE).
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
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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.
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.
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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.
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.
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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 yellow or blue border next to the word
"Print.")
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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.
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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.
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Assessment Updates
If your client has had a previous Psychosocial Assessment under your Program of Admission, 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.
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.
Risk Assessment Form
When to complete the 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.
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. Otherwise, your
supervisor may need to complete the form.
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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.
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
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.
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 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.
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When to complete the form: The CANS/ANSA form in Avatar is completed in conjunction with the
Access Assessment and then every six months. For legacy clients (clients receiving services prior to
4/1/16) the biannual due dates are determined by the date of the original Treatment Plan Anniversary
date (Coordinated Care Date) for legacy clients. For new clients (clients opened on or after 4/1/16) the
opening to the LE determines the due dates.
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:
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. (See above for information on how to determine your biannual assessment dates.)
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.
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Shown below, if 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.
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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.
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
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"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.
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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.
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Admission Diagnosis
When to complete the Diagnosis form
Every episode requires a diagnosis. Without a diagnosis, no services can be billed. The date of
diagnosis must be on or before the date 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 is to enter the diagnosis time as 12:00 am.
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. However, the diagnosis
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may be updated at the time of the annual assessment or at any time. See the next section for more
information.
major depression
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 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 Behavioral Health clients, the Admission Program is LE –
00044 MH COUNT OUTPATIENT, or possibly, County – Pre Admit Outpatient. You can now
view the current diagnoses to see if you want to update or not.
This next section describes how to add a diagnosis for a client that does not have a previous diagnosis.
The following section describes how to complete an 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. Enter appropriate information in the required Type of Diagnosis and 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.
6. 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.) (Hint: If you type “0000” the time will automatically enter as 12:00 AM.)
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Since this is an admission diagnosis, there will not be a diagnosis from which to default.
However, if you are working with a client who has a previous diagnosis, you will be prompted to
choose whether or not you want to select information from a prior diagnosis. Use the Select
Episode To Default Diagnosis Information From and Select Diagnosis Entry To Default
Information From drop-down menus to do this. If you select a default diagnosis, any previous
diagnoses for this
client will be added
to the form. See the
next section on how
to update when
there is already an
existing diagnosis in
Avatar.
7. 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.
8. Type in a diagnosis in the Diagnosis Search field, then click “Enter” on your keyboard.
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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.
9. 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.
10. 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.
11. Enter Present on Admission Indicator, if applicable.
12. DO NOT ENTER Classification. THIS NO LONGER APPLIES.
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13. 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:
14. Add To Problem List: Enter Yes. By clicking Yes you add this diagnosis to the problem list
that is used in creating the treatment plan. Typically, you will click Yes when answering this
question.
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15. On the Additional Diagnosis Information section, if applicable, enter Prognosis, Estimated
Discharge Date, Trauma (CSI), General Medical Condition Summary Code (CSI), Substance
Abuse / Dependence (CSI), Substance Abuse / Dependence Diagnosis (CSI).
16. Click Submit.
Diagnosis Update
For all Admission Programs, a current diagnosis is required. Without a diagnosis, no services
can be billed.
When to complete an Update: The Diagnosis form in Avatar must be completed in conjunction with the
client’s Access Assessment. Each admission program must have its own diagnosis. Without a diagnosis,
no services can be billed. 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. However, the diagnosis 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.
TO VIEW 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 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
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you provide services. For County Behavioral Health clients, the Admission Program is LE –
00044 County BH 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
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.
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5. You will get a popup
warning you, “All
unsaved data will be
lost. Do you want to
continue?” Click, “Yes.”
6. Select Diagnosis
Entry To Default
Information From:
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.
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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 check
boxes or drop down list items.) If you have done this right, none of the radio buttons
in this field will be clicked.
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b. Change the Bill Order number. This question is required and thus must have data in
it. Enter a high number such as “100.”
5. Once you have resolved the diagnosis/diagnoses you don’t want, add the new
diagnosis/diagnoses as shown previously and then click “Submit.”
The Santa Cruz County Integrated Treatment Plan
Integrated treatment planning is part of the movement toward integrated care. An integrated treatment
plan shared across agencies, 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, and decreased hospitalizations, 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 agencies and providers, with teams and treatment providers adding goals,
objectives and interventions as needed. If clients wish to participate and sign a consent form, treatment
plans for Behavioral Health and Substance Use Treatment will be viewable by each agency.
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Treatment Plan Overview
Integrated Treatment Planning and Due Dates
The Plan Anniversary Date or Plan Date for the treatment plan is shared. For information on
how this date is determined, see the document entitled, “How to Find Your Plan Anniversary
Date.”
As clients are opened to new services - goals, objective and interventions are added to the plan.
All items, no matter when they are added, expire the day before the anniversary date.
Problems, goals, objectives and interventions can be viewed by all of the treatment providers
for the client. If a new goal, etc…is added in the middle of a client's annual cycle, that goal will
still expire one day before the Plan Anniversary 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 Admission Program on January 15, 2017. The client is
referred to case management and psychiatry. The case manager completes a treatment plan.
The goals initiated by the case manager are valid from January 15, 2017 through January 14,
2018.
Then, on July 15, 2017 the client begins psychotherapy. The psychotherapist adds treatment
plan goals to the treatment plan already in effect. Those psychotherapy goals are in effect from
July 15, 2017 through January 14, 2018.
Admission
Treatment Plan Update 1
Initial Treatment Plan
Dates: Jan 15, 2017 to Jan
14, 2018
Date: A new goal, objective
and intervention is added
on Jul 15, 2017
Plan Name: 01/15/1701/14/18 Initial
Plan Name: 01/15/1701/14/18 Update 1
Annual Expiration Date for
All Treatment Plan Goals
Everyone Writes a New
Goals, etc....
Dates: Jan 15, 2018 to Jan,
14, 2019
Plan Name: 01/15/1801/14/19 Annual
There are two pages to the Treatment Plan form.
On the first page, the following items are addressed:
 Plan name
 dates
 type of plan
 client strengths/challenges
 plan participants
 problems to be addressed (diagnoses)
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The second page of the treatment plan is opened by clicking "Launch Plan Builder.” This is the
area where Goals, Objectives, and Interventions are written.
Once the plan has been finalized, Avatar will create a document that can be viewed in the
client's chart.
Treatment Plans for Monolingual Clients
For clients who do not speak English, the clinician should type both English and Spanish into the plan.
The format is [English text] / Spanish translation text]. For each item, the English first, then a slash, then
the Spanish text.
Creating an Initial 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, on the anniversary of the opening date.
For clients who were open to services before 4/1/16, the anniversary date is set by the Transition Plan.
See the document titled, “How to Find Your Treatment Plan Anniversary Date,” which is on the Avatar
website, for more information.
STEPS:
This shows you how to create a plan for a brand new client who does not have a treatment plan. For
training purposes, use a client that does not have any existing 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 Treatment Plan. Double-click on the link.
2.
This will open up the display area for any
previously written treatment plans. However, 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.
3.
In the far upper right hand corner, click on Add to
create the first treatment plan for your client. The first page of the Treatment Plan form will
open.
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4.
Plan Naming Conventions
a. Because goals will 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. Plan Names
indicate the annual authorization for the plan (when the plan year starts and when it
end) and what type of plan it is (initial, annual, update).
Examples of Plan Names:
04/05/16 – 04/04/17
04/05/16 – 04/04/17
04/05/16 – 04/04/17
04/05/17 – 04/04/18
04/05/17 – 04/04/18
04/05/17 – 04/04/18
Initial
Update 1
Update 2
Annual
Update 1
Update 2
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 with a new
goal with today's date.)
5.
In the Plan Type field, click the down-arrow to
reveal the drop-down menu. Single-click to select
Initial.
6.
Note the “MH Treatment Plan
Documentation” link which points to
helpful clinical information about filling
out a Treatment Plan.
7.
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.
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8.
In the Plan Date field, enter the beginning date of the plan, which is the date the client was
opened to services. (See the Client Episodes Widget to get the date.) Type in the date or use
the calendar icon to select a date, then tab or click out of the field. The Plan End Date and
Next Review Date should auto-populate after tabbing out of the Plan Date field. The Plan End
Date will automatically be entered as one year minus one day from now. The Review Date will
be one month before the Plan End Date. Note that on the Review Date, a message will be sent
to you in your My To Do’s, reminding you that the plan is due.
9.
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?
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10.
Problems Section (Table):
The problems section is a multi-iteration
table. You will add each of the client's
problems as one line on the table.
When you open up the plan, you may find
that there are already problems in the
plan. These problems come from the
diagnosis form and also from any prior
episodes the client may have had. 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. Double-click on the entry of your
choice, or single-select the item of your
choice and click the Select button. For
your Treatment Plan, you may use any
preexisting problems, or you may add
new problems. Form training purposes,
you will practice adding a new problem.
SNOMED CODES
•In Avatar, Problems can be both Diagnoses or
other types of problems called SNOMED Codes.
Only licensed/waivered/registered staff can add
Diagnoses. This is done through the Diagnosis
form, not in the Treatment Plan. If you are not
licensed/waivered/registered, by the time you are
ready to complete the client’s first treatment plan,
the Diagnosis form will have been completed by
someone else. These diagnoses will show up in the
Treatment Plan form. You can choose to create
your treatment plan with the diagnoses (or
Problems) already in Avatar, or you may add your
own Problems (or SNOMED Codes) to work on at
this time. Examples of SNOMED Codes are social
isolation, homelessness, family stress. Do note that
if you choose to work on a problem like this, you
must tie the problem back to the client's diagnosis
in the Treatment Plan and in your other
documentation. For example, if you choose the
problem of social isolation, you should document
how this problem ties back to the client’s diagnosis
of depression or anxiety.
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STEPS
a. Enter a new problem by clicking the New Row button. For each problem added, you
must create a new row in the table.
i. 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.
b. DO NOT USE THE TYPE FIELD.
c. Double-click in the Date Identified field to activate the field. This is an optional field.
Enter a date if appropriate.
d. 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 1st. For example,
01/01/1972.
e. 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. See the section titled, “How to Resolve
Problems,” for more information on how to do this.)
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f.
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.
g. 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.
h. 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.
11.
Plan Participants Section: The Plan Participants Section is also a multi-iteration table. You will
add each of the plan participants (client, parent, guardian, etc…) as one line on the table.
Enter each participant by clicking the New Row button. (For the first row in the table, you will
enter yourself as the clinician.)
a. Double-click in the Role field to activate the field. Click Staff in the pop-up window.
b. In the Staff ID field type in your last name and click enter. Your name should
automatically auto populate into Staff ID and Participant Name fields.
c. Enter Yes in the Plan Author field.
d. 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.
e. To add your client (or another participant) click New Row.
i. Double-click in the Role field to activate the field. Click External Participant in
the pop-up window.
ii. Skip the Staff ID field.
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iii. In the Participant Name field, type the name of the client.
iv. Enter No in the Plan Author field.
v. Enter No in the Notification field.
a. 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. Your client will sign on the pad and then Avatar will
import the signatures into the document. However, don’t obtain the signature until you
have completed the plan.
b. Add your supervisor if needed: If you are required to have a supervisor sign off on your
plan, you may add that person to the plan as well.
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.
12.
13.
14.
15.
16.
17.
In the Date client was offered a copy of the treatment plan field, enter the date.
If the client does not sign the treatment plan, enter the reason why in the next field titled If
client has not signed the treatment plan, please explain:
Add Additional Comments About Client’s Support System as needed.
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.
In the Treatment Plan Status field, select Draft
status radio button. Then click the CLICK HERE to
Launch Plan Builder button.
You should now see the Treatment Plan Builder
portion of the form with your problems from the
Problem List on the first page displayed.
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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.
18. Click to highlight one of the problems brought over from the first page of the Treatment Plan.
The problem selected will be highlighted green and the problem code, Date of Onset, and Status
(Problem List) fields are populated/disabled.
19. Add the Date Opened, Date Due and Staff Responsible to the highlighted Problem. The Date
Closed field should remain blank. (You use this field later, when you resolve problems, etc…in
the plan.) The Status should remain Open. Date Closed is not required for a new plan because
all the problems, goals, objectives and interventions are open. In an annual plan, when you
resolve goals, etc… you change the Status to Resolved and enter the end date for the goal, etc...
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20.
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.
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a. Highlight the problem to which you want to add a goal.
b. Click Add New Goal
c. Enter the goal in the field below titled Goal.
d. Date Opened: This is the opening date of the plan. If you forgot the opening date, look
at the Client Episodes Widget. The Opening Date for the plan is the Admit Date.
e. The status of the goal should be Open.
f. Date Closed is not required for a new plan.
g. Date Due is the end date for the plan.
h. Enter Staff Assigning and Staff Responsible. Typically you would be the Staff Assigning
and Staff Responsible. Check with your supervisor to see if your workflow involves staff
assigning items to other staff besides yourself.
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21.
New Objective: You will now add a new objective to the goal you just wrote.
a. First, click on the goal you just wrote – the text in the view of the goals above. The text
of the goal should now be highlighted in green. This way, your goal will be associated
with the new objective.
b. Click the Add New Objective button to open a blank objective.
c. Enter the data in the Objective field, Including Baseline field.
d. Enter a date in the Date Opened, Date Due and Staff Responsible.
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22.
New Intervention: You will now add a new intervention to the goal you just wrote. This
section is similar to the Objective section. Make sure you click and highlight in green, the text
from the Objective you just wrote, before clicking Add New Intervention. In the intervention,
add your Service Program, so other clinicians know which program your intervention is
associated with. See below for instructions.
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, 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 had 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.
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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.
23.
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.
YOU WILL NOT BE ABLE TO FINALIZE
YOUR PLAN IF THERE ARE RED FLAGS.
PLANS LEFT IN DRAFT ARE INVALID AND
YOU RUN THE RISK OF YOUR PLAN
BEING DELETED.
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24. If you are finished with your Treatment Plan, in the Treatment Plan Status field, select the Draft
or Final radio button. As with other Avatar documents, if you select Draft, the Treatment Plan
will show up on your To Do List to remind you to complete and finalize the Treatment Plan. You
can re-open your draft by clicking on the link.
25. Select the Submit button in the Navigation panel on the left to save and close your treatment
plan.
26. 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 also route to a supervisor or others.
Printing a Copy of Your Treatment Plan
1. Return to your client’s chart.
2. Click on SC MH Treatment Plan to open the Treatment Plan Inquiry View.
3. Click Report for a formatted version treatment plan.
4. You may also click Print. This will print what you see on the page, which is not formatted.
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
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5. You will now see a formatted version of the Treatment Plan which you can print out and give to
the client. If you do not have a signature pad available, use the printout to obtain the client
signature and then have the plan to be scanned into the chart.
6. The report is going
to launch in a
separate window.
Click on the large
Avatar icon at the
bottom of your Windows desktop. Note that it may take several minutes to generate a report.
Be patient.
7. Once you have the report opened, click on the little picture of the printer in the upper left-hand
corner of your screen to print.
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8. See the next section for information about the workflow with printed treatment plans where
you do not have a signature pad.
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This is the signature
area at the end of the
treatment plan report
for wet signature.
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. First, print out a copy of your draft treatment
plan. Do not finalize the treatment plan until you obtain the signature. If the client 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 above.
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3.
4.
5.
6.
Meet with client to obtain the signature.
Submit the signed paper plan for scanning into the chart.
Reopen to the Draft Treatment Plan in Avatar.
In the Date client was offered a copy of the treatment plan field, 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.
8. Finalize and submit the electronic Treatment Plan to Avatar.
To View Your Scanned Treatment Plan
Links to scanned documents are located in a 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.)
Although most MH plans are not episodic, plans are filed by
episode. Click on the tab for your Admission Program to find the
scanned plans for your program.
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Creating a Treatment Plan Update for New Services
You will create an update when you want to add new services midway through the client’s plan year or
authorization period. For example, you are a therapist who has a new client. Your client already has a
case manager and a psychiatrist and they’ve completed the tx plan a while ago. You are starting services
somewhere mid-year in the Tx Plan cycle. You want to add your goals, etc…to the existing plan.
When you do this, you are adding to a shared plan. You want to preserve the problems, goals, objectives
and interventions that others have added. You have seen how treatment plan elements are added to
progress notes. If you do not bring previous items by others into your plan, these other providers won’t
be able to add treatment plan elements to their progress notes.
If you neglect to bring forward treatment plan
items by others, you run the risk of your plan
being deleted.
First, you will need to open a new Treatment Plan form from the client's chart, with the
information from the previous plan defaulted into your new plan. By doing this, you bring forward
all of the previous problems, goals, objectives and interventions that others have already added to
the chart.
STEPS:
1. Open the client's chart if you have not already done so.
2. Click SC MH Treatment Plan in the list of forms on the left in the Chart Overview. You should now
see an Inquiry view of the client’s Treatment Plan(s).
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3. Look through the plans to see which is the most
recent shared plan (skip over the EDC and Telos
plans, these are not part of the shared plan). You
want the most recent shared plan. This is the plan
you are going to add to.
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 send a message to the QI help desk at
askQI@santacruzcounty.us or call
454-4468.
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. Do not use
Telos or EDC plans. An example of a correct set of
treatment plans, in sequence, is shown below.
When picking the plan to default from, you want
to skip over the Telos and EDC plans.
•11/20/2016 – 11/19/2017 Transition Plan
•8/15/2016 – 9/13/2016 TELOS
•9/13/2016 – 12/11/2017 EDC
•11/20/2016 – 11/19/2017 Gap 1
•11/20/2016 – 11/19/2017 Gap 2
•11/20/2017 – 11/19/2018 Annual
•11/20/2017 – 11/19/2018 Update 1
•11/20/2017 – 11/19/2018 Update 2
4. 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.
5. Click Yes when you see
the pop up asking if you
want to, "default plan
information from a
previously entered plan.”
6. 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. Remember to skip over Telos or EDC plans. Do not use these
plans to default information.
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7. Enter Plan Date: You will see a third pop up asking you to enter the plan date. For an Update where
you are adding new services, the plan date is the first day you began services for the client. (For a
Gap Plan, the plan dates goes back to the beginning of the plan year or authorization period.)
IMPORTANT: You cannot adjust the plan 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.
8. Once you have entered the plan date, click OK.
9. You will see yet a fourth pop up asking if you are sure you want to default information from a
previous plan. Click Yes.
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10. Enter the Plan Name:
The plan name contains the whole plan year, even if you add your services in the middle of the plan
year.
Example
If the most recent shared plan was titled:
04/05/16 – 04/04/17 Initial
Your plan update will be titled:
04/05/16 – 04/04/17 Update 1
Example
04/05/16 – 04/04/17 Update 1
04/05/16 – 04/04/17 Update 2
11. In the Plan Type field, you will select Update.
12. The Plan End date and the Next Review Date are auto populated with information from the initial
plan. Note that the problems(s), goal(s), objective(s) and/or intervention(s) you add today still expire
on the Plan End Date and that the timeframe for your additions will likely be less than one year.
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13. Was This Treatment Plan Discussed in a Language Other Than English? Notice that this question is
pre-populated from the previous plan.
14. 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).
15. Plan Participants Section: If needed, add your name and any additional Plan Participants. DO NOT
DELETE ANY PLAN PARTICIPANTS. To add yourself or other participants, click “new row.”
16. Complete the rest of the fields on the Plan Page (first 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 with
your problems from the Problem List on the first page displayed. You will now see the previous
goals, objectives and interventions.
17. Add Your Goal(s), Objective(s), and/or Intervention(s):
IT IS VERY IMPORTANT TO CLICK ON THE PROBLEM, GOAL, OBJECTIVE ASSOCIATED WITH THE
ITEM YOU WANT TO ADD, SO THEY ARE ASSOCIATED CORRECTLY WITH EACH OTHER.
In the example below, to add a new Objective to the Goal, "reduce overall level, frequency and
intensity of anxiety…,” the text of the goal is highlighted in green. This must be highlighted like
this to write a new Objective for this particular problem.
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Red Flags: Remember to clear all the red flags before going back to the Plan Page. Red
Flags tell you that the goal/objective/intervention has not been completed. All of the red
flags must be gone before you can finalize and submit your treatment plan. Plans left in
draft are invalid.
18. 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.
19. If you are finished with your Treatment Plan, in the Treatment Plan Status field, select the Final
radio button.
Creating a Treatment Plan Update for Updating Problems, Goals, Objectives and
Interventions
Follow this procedure when you need to update the treatment plan for a client for whom you are
already providing services. You do this when a new treatment plan is not necessarily due, but the
treatment has changed and you want the plan to accurately reflect what you are currently working on in
treatment.
For example, you have a client with a history of outbursts. You have been working on these problems
steadily in therapy and the client has improved to the point where she no longer exhibits angry
outbursts. You want to remove the items associated with this behavior from the plan to reflect the
client’s progress. You may want to add new goals to work on as well.
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This procedure is nearly identical to the update procedure from the previous section, that describes
how to do an update for new services. The difference is that the Plan Date here is the date you update
the plan ("Today") instead of the first date of services.
First, you will need to open a new Treatment Plan form from the client's chart, with the information
from the previous plan defaulted into your new plan. By doing this, you bring forward all of the previous
problems, goals, objectives and interventions that others have already added to the chart.
1. Open the client's chart if you have not already done so.
2. Click SC MH Treatment Plan in the list of forms on the left in the Chart Overview. You
should now see an Inquiry view of the client’s Treatment Plan(s).
3. In the Inquiry View, look through the plans to see which is the most recent shared plan. This
is the plan you are going to add to.
This is a good opportunity to see if there is anything problematic with the treatment plans.
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 send a message to the QI help desk at askQI@santacruzcounty.us or call 454-4468.
4. 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.
5. Click Yes when you see the pop up asking if you want to, "default plan information from a
previously entered plan.”
6. 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, except for Telos
or EDC plans. Do not use
these plans to default
information.
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7. Enter Plan Date: You will see a third pop up asking you to enter the plan date. In this case,
you are not adding new services, but simply changing the plan to reflect a change in
treatment. The plan date is today’s date, the date you are updating the plan. Because you
are not adding on services, you do not have to backdate to the date when services
commenced.
IMPORTANT: You cannot adjust the plan 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.
8. Once you have entered the plan date, click OK.
9. You will see yet a fourth pop up asking if you are sure you want to default information from
a previous plan. Click Yes.
10. Enter the Plan Name: The plan title will have the same start and end dates as the last shared
mental health plan, but with the word Update and a number to differentiate from any
previous updates.
The plan name contains the whole plan year, even if you add your services in the middle of the plan
year.
Example
04/05/16 – 04/04/17 Initial
04/05/16 – 04/04/17 Update 1
Example
04/05/16 – 04/04/17 Update 1
04/05/16 – 04/04/17 Update 2
11. In the Plan Type field, you will select Update.
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12. The Plan End date and the Next Review Date are auto populated with information from the
initial plan. Note that the problems(s), goal(s), objective(s) and/or intervention(s) you add
today still expire on the Plan End Date and that the timeframe for your additions will likely
be less than one year.
13. Was This Treatment Plan Discussed in a Language Other Than English? Notice that this
question is pre-populated from the previous plan.
14. 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).
If there are problems that you will not be using and that you want to resolve, you will first
need to make some changes on the Plan Builder Page. See below.
15. Plan Participants Section: You should not need to make any adjustments to this section if
you are creating a not date to change goals, etc.
16. Complete the rest of the fields on the Plan Page (first 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 with your problems from the Problem List on the first page displayed. You will now
see the previous goals, objectives and interventions.
17. Resolve any goals, objectives and interventions that are no longer needed. See the next
section for information on how to do this.
18. Add new goals, objectives and interventions if desired.
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How to Resolve Goals, Objectives, and Interventions
Before you can resolve any Problems, you need to resolve any of the associated goals, objectives and
interventions. You will also resolve problems when you close a client to services.
Start from the bottom, resolving interventions first, then objectives, then goals.
1. Click on one of the interventions you want to resolve so that it is highlighted in green.
2. Change Status from “Open” to “Resolved”
3. Date Closed = Plan Date
4. Continues resolving interventions. When you have resolved all of the interventions you no longer
need, resolve the objectives, then resolve the goals.
DO NOT resolve any problems, goals or objectives
that are being used by another program. Identify
these items by looking for associated interventions
that belong to another program (not yours).
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How to Resolve Problems
In order to resolve problems in an Avatar Treatment Plan, you must first resolve all of the goals,
objectives and interventions associated with the problem (see above).
Avatar will not allow you to delete problems. You can only resolve them.
Once you have resolved the goals, etc. associated with a problem, return to the Plan Page and resolve
the problem in the problems table.
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."
Enter the Date resolved.
Creating an Annual Plan
This describes how to create an Annual update for your client.
You may finalize and submit your Annual plan up to 28 days prior to the due date, which is the plan
anniversary date. The plan will not take effect until the due date or anniversary date. You will not be
able to see your added treatment plan items in a progress note until the day after the plan 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 the shared plan can create the Annual plan. There is no need to wait for
the county coordinator, or anyone else to start the plan.
Steps:
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1. 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 Treatment Plan in the list of forms on the left in the Chart Overview.
c. Click Add in the upper right-hand corner of the screen to open a new form.
d. Click Yes when you see
the pop up asking if
you want to, "default
plan information from
a previously entered
plan.”
e. Default From Previous:
Select the most recent shared plan.
f. Enter Plan Date: This is the shared plan anniversary date. For clients entering into services on or
after 4/1/16, it is one year from the plan date for the Initial Plan and one day after the Initial
Plan expires. Click OK.
g. You will get a warning that you are entering a future date. This is OK. You may create an Annual
plan up to 28 days prior to the expiration date of the previous plan. 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.
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h. 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.
2. 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 the previous plan(s), just one year later.
Example
If the Initial Plan was titled:
04/05/16 – 04/04/17 Initial
Your Annual Plan will be titled:
04/05/17 – 04/04/18 Annual
Example
If last year’s Annual Plan was titled:
08/02/16 – 08/01/17 Annual
This year’s Annual Plan will be titled:
08/02/17 – 08/01/18 Annual
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3. In the Plan Type field, you will select Annual.
4. The Plan End date and the Next Review Date are auto populated with information from the previous
plan. YOU MAY NEED TO ADJUST THE PLAN END DATE WHICH SHOULD BE ONE YEAR MINUS ONE
DAY FROM THE PLAN DATE.
The plan dates might initially look like this. Note that the Plan End Date is incorrect.
You will need to adjust the Plan End Date to one year later. The Next Review Date will automatically
change. You may get a warning from Avatar about changing the Next Review Date. If this happens, click,
“Yes.”
5. As with previous plans, adjust the plan as needed, resolving and adding problems, goals, objectives
and interventions. Add new plan participants if needed. Edit the Strengths and Challenges as
needed.
6. Click Draft and then click the CLICK HERE to Launch Plan Builder button to go to the Treatment Plan
Builder portion of the form. You will now see the previous goals, objectives and interventions by you
and by others.
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7. Resolve any problems, goals, objectives and interventions that are no longer needed. Change the
Status from “Open” to “Resolved.” Date Closed = Plan End Date
8. Add New Goals, Objectives and Interventions as shown previously.
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 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 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 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 sections on the form that may not apply
to your workflow. Consult with your supervisor on how to best fill out this form.
3. Resolve your problems, goals, objectives and interventions on the treatment plan. DO NOT resolve
items still in use by others. Use the default method to create a duplicate copy of the most recent
shared treatment plan. The plan date is the closing date for your program. The plan type is,
“Update.” Resolve your items as described in the previous sections titled, “How to Resolve Goals,
Objectives and Interventions,” and, “How to Resolve Problems.” On your treatment plan, in the
question, “If client has not signed the treatment plan, please explain,” type in the following: “Client
is discharging from __________ program. Problems, goals, objectives and interventions have been
resolved or closed as indicated in the problems table and on plan builder page.” Finalize and submit
the plan. Do not leave the plan in draft.
4. Send a message to county data entry (Sylvia Vairo) to have the client removed from your
caseload.
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5. Check to see if your client is open to other services within your Program of Admission. For
example, for County Mental Health (LE – 00044 Mental Health Outpatient), check to see if the client
has a therapist, a psychiatrist, or any other provider associated with the Admission Program.
6. If the client is discharging completely from all services within your Program of Admission, 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. If the client is still getting other services under your
Admission Program, the discharge form is not necessary. For most episodes (e.g. LE-00044 MH
County Outpatient), you will use the Discharge form. (For the County – Pre Admit Program of
Admission, you will use the “Pre Admit Discharge form”, not the regular Discharge form.)
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Avatar Clinicians Manual - County of Santa Cruz Health Services

Transcription

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