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Oklahoma Administrative Code (Last Updated: March 11, 2021) |
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TITLE 450. Department of Mental Health and Substance Abuse Services |
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Chapter 27. Standards and Criteria for Mental Illness Service Programs |
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Subchapter 7. Clinical Services |
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Part 1. REQUIRED SERVICES |
SECTION 450:27-7-3. Assessment services
Latest version.
- (a) Facility policies shall describe, upon determination of appropriate admission to the facility service(s), the procedures by which assessment and admission occur.(b) The consumer assessment shall be completed by an LBHP or licensure candidate and shall include, but not be limited to, the following informaiton:(1) Behavioral, including mental health and addictive disorders as well as the following;(A) presenting problem and current symptomology;(B) previous treatment history;(C) current and past psychotropic and addiction medications, including name, dosage and frequency; and(D) Family history of mental health and other addictive disorders.(2) Emotional, including issues related to past or current trauma and domestic violence;(3) Physical/medical including;(A) health history and current biomedical conditions and complications;(B) current and past physical health medications, including name, dosage and frequency.(4) Social and recreational, including;(A) family and other relationships;(B) recovery and community supports;(C) leisure and wellness activities; and(D) culture, including traditions and values.(5) Vocational, including;(A) educational attainment, difficulties, and history;(B) current or previous military service including discharge status; and(C) current and desired employment status.(c) The facility shall have policy and procedures specific to each program service which dictate timeframes by when assessments must be completed and documented.(d) The policy shall specify how screening and assessment information is maintained and stored in the event the consumer is not admitted for program services,(e) The consumer, family as appropriate, and others as appropriate and approved by the consumer shall be an active participant(s) admission and assessment process.(f) Compliance with 450:27-7-3 shall be determined by a review of clinical records, and policy and procedures.