• Home

Patient Summary Report Example

 
Employ a multidimensional approach in diagnosing the patient.
  1. Patient Summary Report Example Template
  2. Patient Summary Report Example Sample
Report

Patient Summary Report Example Template

REPORT NUMBER: EXAMPLE REPORT AUDIT: Name of Facility Admitting and Registration AUDIT DATE: Date AUDITOR: Auditor Name, CPA, Audit Manager 231 South Bemiston Avenue www.chanllc.com Suite 300 Tel: 314.802.2000 Clayton, Missouri 63105 Fax: 314.802.2020 INTERNAL AUDIT REPORT Attachment I. The Patient Summary uses exclusively coded data (for example using the International Classification of Diseases (ICD) for diseases and Anatomic Therapeutic Chemical Classifications for drugs, or SNOMED-CT). Patient Summary Form PSF-750 (Rev: 7/1/2015) Patient name Last First MI Patient insurance ID# Patient address Provider Completes This Section: Female Male 1 2 3 Traumatic Unspecified Patient Type Repetitive Cause of Current Episode 2° Patient date of birth City State Zip code 7. Address of the billing provider or facility indicated in box #1 8.

ExampleSummary

Patient Summary Report Example Sample

The Diagnostic and Statistical Manual of Mental Disorders is used to categorize psychiatric diagnoses. However, the format is changing. The new format begins with the 'principal diagnosis' and this condition should be followed by the phrase 'principal diagnosis' or 'reason for visit.'[16] Insurance companies may still require the old method, which assesses five dimensions (Axis). Include a diagnosis for each axis:
  • Axis I: Primary presenting problem (such as major depressive disorder or bipolar disorder).
  • Axis II: Personality disorder (ex: borderline personality disorder) or intellectual disability
  • Axis III: Medical problems (only MDs can diagnose these)
  • Axis IV: Psychosocial and Environmental Problems
  • Axis V: Global assessment of functioning (GAF) is a numerical rating on a scale of 0 - 100 of the client's current functioning with the life stressors he or she presents with. A GAF score of 91-100 means the patient is high functioning and easily managing the stressors in his or her life. A GAF score of 1-10 indicates that the patient is a danger to himself and/or others.[17]