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TRAINING
Home
About
Programs
Momentum’s Outpatient Mental Health Clinic (OMHC)
Psychiatric Rehabilitative Program Adult & Minor (PRP)
LGBTQ+ Division (PRP)
Substance Abuse Treatment
Client Info
Client instructions
Client Portal Login
Referral Form
Become a client today!
Resources
FAQ
Contact
Staff Portal
TRAINING
PEER REVIEW
Step
1
of
4
25%
Review Date:
(Required)
MM slash DD slash YYYY
Program:
(Required)
Mental Health
Medication Management
Psychiatric Rehabilitation
Reviewer Name:
(Required)
First
Last
Email:
(Required)
Credentials:
(Required)
Email:
(Required)
Email:
(Required)
Consumer Name:
(Required)
First
Last
Status:
(Required)
Active
Discharged
Unable to tell
Admission Date:
(Required)
MM slash DD slash YYYY
Discharge Date:
(Required)
MM slash DD slash YYYY
Review each section below. For each item that has a"No" response, provide a comment.
1. ORIENTATION/ASSESSMENT
a. Has a comprehensive orientation been completed?
(Required)
Yes
No
Reviewers Comments:
(Required)
b. Was the assessment process thorough, complete, and within the guidelines for timely completion?
(Required)
Yes
No
Reviewers Comments:
(Required)
c. Were the individual’s strengths, abilities, needs and preferences, desired outcomes and expectations assessed during the assessment?
(Required)
Yes
No
Reviewers Comments:
(Required)
2. INDIVIDUAL PLANNING
a. Has an individual plan been completed?
(Required)
Yes
No
Reviewers Comments:
(Required)
b. Are goals & objectives comprehensive and based on the assessment?
(Required)
Yes
No
Reviewers Comments:
(Required)
c. Are the goals and objectives based on the input of the person served?
(Required)
Yes
No
Reviewers Comments:
(Required)
d. Are the anticipated time frames for the goal/objectives specified?
(Required)
Yes
No
Reviewers Comments:
(Required)
e. Are objectives written in terms of specific, measurable behaviors?
(Required)
Yes
No
Reviewers Comments:
(Required)
f. Do the noted external programming needs address all areas identified in the assessment that were not covered by internal goals and programming?
(Required)
Yes
No
Reviewers Comments:
(Required)
3. PROGRESS NOTES: Review progress notes and answer the following questions by circling “Yes” or “No.” Explain any “no” responses in the “Reviewer Comments” section.
a. Do the progress notes clearly describe progress toward goals and objectives on the individual plan?
(Required)
Yes
No
Reviewers Comments:
(Required)
b. Were services provided consistent with the intervention areas identified on the individual plan?
(Required)
Yes
No
Reviewers Comments:
(Required)
c. Do the notes indicate an ongoing assessment of the individual’s needs in important life areas?
(Required)
Yes
No
Reviewers Comments:
(Required)
d. Do the notes explain the reasons why continued services are necessary?
(Required)
Yes
No
Reviewers Comments:
(Required)
e. If there has been a reformulation or change in services, are the changes reflected on the Individual Plan according to guidelines regarding review and treatment plan updates?
(Required)
Yes
No
Reviewers Comments:
(Required)
4. FOLLOW UP
a. With regard to individuals who have dropped out of programming, not shown up for services, or left against advice of staff, have appropriate attempts been made to re-engage them in services?
(Required)
Yes
No
Reviewers Comments:
(Required)
5. ADDITIONAL SERVICE RECOMMENDATIONS: What additional services which are currently not assigned might this individual benefit from? Provide an explanation for any additional services you would recommend.
Additional Service(s) Recommended:
Reviewer's Reason for Recommendations:
Additional Service(s) Recommended:
Reviewer's Reason for Recommendations:
6. QUALITY OF TRANSITION/DISCHARGE PLANNING
a. Did the discharge planning process begin at the onset of services and continue throughout services?
(Required)
Yes
No
Reviewers Comments:
(Required)
b. Were the person served and family members actively involved in the discharge planning process?
(Required)
Yes
No
Reviewers Comments:
(Required)
c. Based on the progress notes and other documentation, was the decision to discharge the person appropriate with regard to the program’s discharge criteria?
(Required)
Yes
No
Reviewers Comments:
(Required)
d. Does the discharge plan contain referrals and/or specific recommendations to assist the person to maintain and/or improve functioning and increase independence?
(Required)
Yes
No
Reviewers Comments:
(Required)
7. OVERALL DOCUMENTATION/RECORD ORGANIZATION:
a. Is the record organized in a manner that is easy to follow the course of treatment, and all necessary documents are available in the record?
(Required)
Yes
No
Reviewers Comments:
(Required)
b. Are all services that were provided documented in accordance with agency policy and procedures?
(Required)
Yes
No
Reviewers Comments:
(Required)
Reviewer Signature:
(Required)
