Page 118 - R2P Front Desk Manual v1

8. Under Patient Completes This Section, information from the completed PSF will be
used to fill in the fields. *Coordinators should have PTs review the PSF before
submitting an auth request to make sure that what/how the patient was feeling (as
communicated to the PT) is accurately reflected in their responses on the form.* This is
also where a PT can indicate if the patient was sick, had a setback, was out of town, etc.
a. When instructing a patient on how to complete the form, ask the patient to be as
detailed as possible. The completed PSF is the only information Optum’s Case
Manager will use to determine if authorization is approved or denied.
i. Symptoms began on: Must be in MM/DD/YYYY format - if the patient is
unsure of the exact date, enter the 1st of the month they can recall.
ii. Briefly describe your symptoms: Encourage the patient to include any
Activities of Daily Living that may be affected (i.e. walking up stairs, lifting
an object over their head, etc.). It is helpful for the patient to complete the
outcome measure before filling out the PSF to get an idea of affected
ADLs.
iii. How is your condition changing, since care at this facility? If it is the
initial evaluation, select N/A - This is the initial visit.
b. A PSF must be completed each time the clinic has to request authorization - at
the initial evaluation, and any time throughout a patient’s treatment when all
approved visits have been used or expired and new authorization is needed (re-
eval).

Last Update: 7/10/19