MM PEER REVIEW

CARF: MM Peer Review

Step 1 of 3

Review Date:(Required)

Program:(Required)

Reviewer Name:(Required)

First Last

Credentials:(Required)

Email:(Required)

Consumer Name:(Required)

First Last

Status:(Required)

Admission Date:(Required)

Discharge Date:

EVALUATION/ASSESSMENT: Review the Orientation and Assessment process and determine whether or not the assessment process was thorough. Answer the following questions by selecting “Yes” or “No”; explain any “No” response in the “Reviewer Comment” section.

1. Is there a current psychiatric evaluation on file?(Required)

Reviewers Comments:(Required)

2. Does the assessment accurately support the diagnosis present?(Required)

Reviewers Comments:(Required)

INTEGRATED CARE: Review the most recent Individual Plan and answer the following questions by circling “Yes” or “No”. Explain any “No” response in the “Reviewer Comment” section. If the plan has expired, go ahead and answer the questions. If there is no plan in the record, indicate that the plan is missing in the “Reviewer Comment” section and do not answer the questions.

3. Is there evidence of primary care coordination? (telephone / written)(Required)

Reviewers Comments:(Required)

4. Is communication with primary care physician indicated at this time?(Required)

Reviewers Comments:(Required)

LAB WORK: Review progress notes and answer the following questions by circling “Yes” or “No.” Explain any “no” responses in the “Reviewer Comments” section.

5. Is the prescriber requiring lab work on a regular basis?(Required)

6. Last Date Requested:(Required)

Reviewers Comments:(Required)

The last date requested.

MISCELLANEOUS

7. For each medication, are the client’s needs and preferences taken into consideration?(Required)

Reviewers Comments:(Required)

8. Is the client eligible for generic medications, and if so, are they being prescribed?(Required)

Reviewers Comments:(Required)

9. Is there evidence of co-existing medical conditions / potential medication impact?(Required)

Reviewers Comments:(Required)

10. Is the AIMS being completed? (every 6 months)(Required)

Reviewers Comments:(Required)

11. Has potential drug interactions been addressed, including over-the-counter or homeopathic supplements?(Required)

Reviewers Comments:(Required)

12. Is there evidence of combining prescription and non-prescription medication, including alcohol, tobacco, caffeine, illicit drugs and alternative medicines?(Required)

Reviewers Comments:(Required)

13. Is there evidence that weight and blood pressure being monitored on a regular and consistent basis?(Required)

Reviewers Comments:(Required)

COMMENTS

14. Are there potential implications between medication and diet / exercise?(Required)

Reviewers Comments:(Required)

15. How often is the client seen for medication management services, is this adequate? (frequency of prescribing)(Required)

Reviewers Comments:(Required)

16. Is the client compliant / partial adherence with medications?(Required)

Reviewers Comments:(Required)

17. Is the client compliant with appointments?(Required)

Reviewers Comments:(Required)

18. Is the client receiving medication through the Patient Assistance Program?(Required)

Reviewers Comments:(Required)

19. Has the client had more than 3 medication changes in the last year?(Required)

Reviewers Comments:(Required)

20. Are there early signs of relapse due to medication efficacy?(Required)

Reviewers Comments:(Required)

21. Is there proof of education been provided regarding side effects: risks, benefits, and reasons for taking medication?(Required)

Reviewers Comments:(Required)

INFORMED CONSENT

22. Is there documentation or confirmation of informed consent for each medication prescribed, when possible?(Required)

Reviewers Comments:(Required)

BENZODIAZEPINES

23. Has the client been prescribed benzodiazepines?(Required)

24. If prescribed benzodiazepines, are there substance abuse issues?(Required)

Reviewers Comments:(Required)

25. Have random drug screens occurred?(Required)

Reviewers Comments:(Required)

26. Does documentation show efforts to lower dosage?(Required)

Reviewers Comments:(Required)

ATYPICAL ANTIPSYCHOTICS

27. Has the client been prescribed atypical antipsychotics? If so, has screening and monitoring per APA guidelines occurred?(Required)

Reviewers Comments:(Required)

TREATMENT PLANNING

28. Has progress been made toward treatment plan / goals? (significant improvement, maintaining gains, condition worsened)(Required)

Reviewers Comments:(Required)

29. Has the treatment plan / goals been updated / revised as needed?(Required)

Reviewers Comments:(Required)

REFERRAL

30. Have referrals been made for other services? Has follow-up occurred?(Required)

Reviewers Comments:(Required)

FEEDBACK

Reviewers Comments/Recommendations:(Required)

Reviewer Signature:(Required)

MM PEER REVIEW

CARF: MM Peer Review

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