2009 - physician certification form by compliancedoctor

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This manual contains every policy and procedure you would need to have in order to obtain accreditation for ambulatory outpatient behavioral health businesses to include dual diagnosis, pysch disorders, drug detox, etoh detox. This manual has everything you need and is fully customizable to meet your individual facility needs.

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									                                    PHYSICIAN CERTIFICATION

Patient Name:                                                                    MR#:

CERTIFICATION - ADMISSION *
I certify that the patient would require inpatient psychiatric care if the partial hospitalization services were
not provided and services will be furnished under the care of a physician, and under a written plan of
treatment.

Physician:                                                                       Date:

RE-CERTIFICATION (Every 30 days) *
I certify that continued partial hospitalization services are medically necessary to improve and/or maintain
the patient’s condition and functional level and to prevent relapse or hospitalization.

Physician:                                                                       Date:

RE-CERTIFICATION (Every 30 days) *
I certify that continued partial hospitalization services are medically necessary to improve and/or maintain
the patient’s condition and functional level and to prevent relapse or hospitalization.

Physician:                                                       
								
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