Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 63 - Community Support Programs For Chronically Mentally Ill Persons › Section DHS 63.10 - Assessment and treatment planning

Current through June 24, 2024
(1) ASSESSMENT.
(a) An initial assessment shall be done at
				the time of the client's admission to the CSP, and an in-depth assessment shall
				be completed within one month after a client's admission. The physician shall
				make a psychiatric assessment of the client's need for CSP care and appropriate
				professional personal shall make a psychiatric and psychosocial assessment of
				the client's need for CSP care.
(b)
				The assessments shall:
1. Be clearly
				explained to the client or guardian, if any, and, when appropriate, to the
				client's family;
2. Include
				available information on the client's family and the client's legal, social,
				vocational and educational history; and
3. Be incorporated into review and revisions
				of the client's treatment plan under sub. (2).
(c) A clinical coordinator shall include a
				signed statement in the client's treatment record that the assessments under
				par. (a) were performed by appropriate professional personnel specified under
				s.
				DHS
				63.06(4) (a) 1. to 8.
(d) The in-depth assessment shall include
				evaluation of the client's:
1. Psychiatric
				symptomatology and mental status, by a psychiatrist and by the clinical
				coordinator or a designated staff member meeting qualifications under s.
				DHS
				63.06(2) (c). Utilizing information
				derived from the evaluation required under this subdivision, a psychiatrist or
				a clinical psychologist shall make a psychiatric diagnosis;
2. Use of drugs or alcohol, or both, by a CSP
				professional supervised by the clinical coordinator or a designated staff
				member meeting qualifications under s.
				DHS
				63.06(2) (c);
3. Vocational and educational functioning, by
				a CSP professional supervised by the clinical coordinator or a designated staff
				member meeting qualifications under s.
				DHS
				63.06(2) (c);
4. Social functioning, by a CSP professional
				supervised by the clinical coordinator or a designated staff member meeting
				qualifications under s.
				DHS
				63.06(2) (c);
5. Self-care and independent living capacity,
				by a CSP professional supervised by the clinical coordinator or a designated
				staff member meeting qualifications under s.
				DHS
				63.06(2) (c);
6. Relationship with his or her family, by a
				CSP professional supervised by the clinical coordinator or a designated staff
				member meeting qualifications under s.
				DHS
				63.06(2) (c);
7. Medical health, by a psychiatrist or
				physician. A registered nurse may collect health-related information and
				history and perform partial examinations under supervision of a
				physician;
8. Dental health
				information and history may be collected by a psychiatrist, a physician or a
				CSP professional under the supervision of a physician; and
9. Other specified problems and needs, by a
				CSP professional supervised by the clinical coordinator or a designated staff
				member meeting qualifications under s.
				DHS
				63.06(2) (c).
(e) Evidence that a service is medically
				necessary shall be indicated through the signature of a psychiatrist on the
				client's treatment record following the psychiatrist's review and approval of
				the service.