Overview
These are commonly used clinical documents. We refer to them as sets because the documents in a particular set work together. For example, rather than typing in the same information from one document to the next, we've automated this for you using a feature called dataflow. These sets are free to all Procentive and Procentive RCM customers.
What's in a Form Set?
A form set typically includes an assessment, treatment plan, progress note and a discharge summary.
Commonly Used Sets
- Mental Health
- Chemical Dependency Rule 25/31- Simple Version
- Chemical Dependency Rule 25/31- Expanded Version
- ARMHS
- CTSS
- EIDBI
- Housing
Mental Health
- PRO-1109 MH Diagnostic Assessment
- PRO-1113 Alternate Diagnostic Assessment
- PRO-1202 MH Treatment Plan
- PRO-1307 MH Progress/Case Note
- PRO-1308 MH Group Progress Note
- PRO-1404 MH Discharge Summary
Chemical Dependency Rule 25/31- Simple Version
- PRO-1133S Comprehensive Assessment
- PRO-1134S Comprehensive Assessment Summary
- PRO-1233S Individual Treatment Plan
- PRO-1335S Progress Note and Treatment Plan Review
- PRO-1433S Summary at Termination of Services
NOTE: The above set was designed using this MN DHS documentation: Requirements for Rule 31 clinical documents
Chemical Dependency Rule 25/31 - Expanded Version
- PRO-1125 State Rule 25 Assessment
- PRO-1127 Rule 25 Assessment Placement Summary
- PRO-1131 Comprehensive Assessment
- PRO-1132 Comprehensive Assessment Summary
- PRO-1140 DAANES Client Admission
- PRO-1231 Treatment Plan
- PRO-1331 Progress Note and Treatment Plan Review
- PRO-1431 Discharge Summary
- PRO-1440 DAANES Discharge
Chemical Dependency 245G - Simple Version
- PRO-245G-1100S Comprehensive Assessment (245GS)
- PRO-245G-1101S Comprehensive Assessment Summary (245GS)
- PRO-245G-1200S Individual Treatment Plan (245GS)
- PRO-245G-1300S Documentation of Treatment Services/Treatment Plan Review (245GS)
- PRO-245G-1301 245G Simple Progress Note
- PRO-245G-1400S Service Discharge Summary (245GS)
- PRO-245G-1000 Initial Services Plan and Vulnerable Adult Determination (245G)
NOTE: The above set was designed using this MN DHS documentation: Requirements for 245G clinical documents
Chemical Dependency 245G - Expanded Version
- PRO-245G-1000 ISP and VA Determination
- PRO-245G-1001 Intake - Client Information
- PRO-245G-1002 Intake - Substance Use
- PRO-245G-1003 Intake - Physical and Mental Health
- PRO-245G-1004 Intake - Legal, Education and Vocation
- PRO-245G-EP1125 State Rule 25 Assessment
- PRO-245G-EP1127 Rule 25 Assessment Placement Summary
- PRO-245G-EP1100 245G Comprehensive Assessment and Summary
- PRO-245G-EP1101 245G Comprehensive Assessment Summary
- PRO-245G-EP1140 DAANES Client Admission 245G
- PRO-1141 DAANES Comprehensive Assessment
- PRO-245G-EP1200 245G Treatment Plan
- PRO-245G-EP1300 245G Progress Note/Treatment Plan Review
- PRO-245G-1302 Individual Progress Note (245G)
- PRO-245G-1303 Group Progress Note (245G)
- PRO-245G-EP1336 DAANES 6 Month Review 245G
- PRO-245G-EP1400 245G Discharge Summary
- PRO-245G-EP1440 DAANES Discharge 245G
ARMHS
- PRO-1115 ARMHS Functional Assessment
- PRO-1214 ARMHS Crisis Plan
- PRO-1213 ARMHS ITP
- PRO-1315 ARMHS Group Note
- PRO-1312 ARMHS Interpretive Summary
- PRO-1313 ARMHS Progress Note
- PRO-1314 Collateral Note
- PRO-1406 ARMHS Discharge Summary
CTSS
- PRO-1114 CTSS Diagnostic Assessment
- PRO-1212 CTSS Treatment Plan
- PRO-1311 CTSS Progress Note
- PRO-1405 CTSS Discharge Summary
EIDBI
- PRO-1158 CMDE Medical Necessity Summary Information (DHS-7108-ENG 8-19)
- PRO-1236 EIDBI ITP and Progress Monitoring (DHS-7109-ENG 8-19)
- PRO-1353 Autism Therapy Progress Note
- PRO-1354 Autism Skill Progress Note
- PRO-1355 EIDBI Progress Note
- PRO-1408 EIDBI Discharge Summary
- PRO-1453 EIDBI Transition and/or Discharge Summary
- PRO-0077 EIDBI Client Rights and Responsibilities
- PRO-0078 EIDBI Provider Agency Responsibilities
Housing
- PRO-HS-1616 Combined Application Form
- PRO-HS-1570 SSI Interim Assistance Authorization DHS-1795-ENG
- PRO-HS-1574 Interim Assistance Agreement (Do not use for SSI) DHS-1795A-ENG 6-20
- PRO-HS-1613 Professional Statement of Need DHS-7122-ENG
- PRO-HS-1568 MH DHS Habitability Inspection Form (DHS-7123-ENG)
- PRO-HS-1609 Authorization for Release of Information About Residence and Shelter Expenses DHS-2952-ENG
- PRO-HS-1608 Signed Personal Statement about Assets for Cash Programs
- PRO-HS-1001 Long-Term Homelessness Eligibility Form
- PRO-HS-1002 MN Housing Third Party Verification Form
- PRO-HS-1003 Housing Services Intake Form
- PRO-HS-1005 Crisis Plan
- PRO-HS-1302 Housing Supervision Note
- PRO-HS-1004 Housing Toolkit
- PRO-HS-1006 Housing Focused Person-Centered Plan DHS-7307-ENG
- PRO-HS-1615 Housing Stabilization Services End DHS-8110-ENG
- PRO-HS-1100 Housing Services Assessment
- PRO-HS-1200 Housing Services Support Plan
- PRO-HS-1300 Housing Services Activity Based Case Note
- PRO-HS-1301 Housing Services IRP Case Note
- PRO-HS-1400 Discharge Summary