Bridge Manual 11.17.2017

PIRC BRIDGE CLINIC
Table of Contents

1. Bridge Clinic Overview:
 Purpose
 Objective
 Goals
 Criteria
 Services
 Logistics

2. Bridge roles and responsibilities:
 Bridge Clinician
 Bridge Prescriber
 Bridge Intake Coordinator

3. Bridge Workflow:
 Completing the Crisis management plan
 Referral and Scheduling
 Providing Mental health resources: A Team process

4. Bridge Clinician Workflow:
 Clinician Schedule
 Documentation
 Huddle responsibilities
 Safe Handoff - SBAR

5. JOB AIDS/FORMS

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Bridge Clinic

Overview/Purpose: To provide an alternative level of care to patients triaged by PIRC via phone or in the ED.
The patient may not meet criteria for a psychiatric inpatient admission, but may require psychiatric services
while they are waiting for outpatient mental health services to begin. Patients and families will receive brief
treatment and crisis intervention through three different levels of care: Care Coordination Calls (CCC), Crisis
intervention appointment and/or Psychiatry Prescriber. Patients may stay in this service for no more than 30
days.

Objective:
 To minimize unnecessary ED visits and inpatient stays,
 To provide crisis management intervention,
 To support transition to ongoing mental health providers

Goals:
To provide an integrated care model to help patients and family members:
 Identify what led to the crisis event
 Identify and develop healthy coping skills
 Safety plan to manage current and future crises
 Improve commitment to ongoing mental health services in the community

Bridge clinic criteria
 Clinic pathway via PIRC/ED or PIRC triaged ED diversion phone call
 No current/active mental health provider(s) or a delay/barrier in contacting and receiving an emergency

appointment with current mental health provider
 Patient not actively suicidal/homicidal with plan within the last 24 hours
 Patient not actively aggressive causing significant harm to others within the last 24-72 hours
 Patient and family demonstrate ability to complete safety plan while in ED
 Patient non DDBP

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Bridge Clinic Services:
1. Care Coordination Calls (CCC) – Phone calls to families/agencies to:

 help link patients/families to community mental health services;
 provide a point of contact to help navigate the mental health system;
 support patient and family through this crisis time and help determine needs

2. Crisis Intervention Appointment: Face to face appointment with a licensed independent social worker or
clinical counselor who will:
 establish collaborative relationship with patient and family;
 identify the presenting problem and precipitants which lead to crisis;
 encourage and explore feelings and emotions;
 generate and explore coping strategies and resources;
 restore functioning through implementation of the Crisis Management Plan

3. Psychiatry Prescriber: Medication evaluation appointments are available for 1-3 visits by a psychiatrist or
APRN. A patient is referred to a bridge Prescriber only by the Bridge Team.

Bridge Clinic Logistics:
• Monday – Friday
• 9am – 5pm
• 30 day utilization period
• Patients receive initial appointment with Bridge Clinician.
• Follow up appointments determined by Bridge Clinician based on patients safety and stabilization
• Burnet Campus Location E 2nd floor and Liberty Campus 2nd floor
• LISW/LPCC appointments daily, 30-60 minutes each. Currently 8 SW/CC providers
• 4 Bridge Psychiatry Prescribers
• 3 Intake Coordinators to provide scheduling and telephonic case management support
• Clinic open year round (closed major holidays)

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Bridge Clinic roles, responsibilities and definitions

Bridge Clinic Therapist:
 Will provide crisis management intervention to referred Bridge patients. This includes but is not limited
to:
o Reviewing crisis management plan with patient/family at initial visit; if plan not completed will
complete with patient/family and provide copy to family.
o Define treatment plan and next steps for patient and family;
o Ask family if they have initiated calling the resources that were provide in order to establish on
going mental health services. Provide additional resource if needed. Help family with any
barriers with establishing ongoing mental health services.
o Schedule follow up appt, if needed, with family by contacting Bridge Intake Coordinator
o Complete all required EPIC documentation.
o If it is determined that patient would benefit from an appointment with a Bridge prescriber,
Bridge therapist will schedule prescriber appt with family by contacting Bridge intake coordinator
and will communicate via EPIC inbox to scheduled prescriber reason for referral and other
helpful information.
o While patient is engaged in Bridge Clinic services ongoing communication will occur via EPIC
inbox “P PSY Bridge Clinic (11284)” with pts Bridge team (i.e. Bridge prescriber/Bridge intake
coordinators) so team is informed about next steps, transition planning etc.…

 When patient is ready to transition from Bridge:
o Bridge therapist will make arrangements for safe handoff and document in EPIC
o Ask if Patient has appointment(s) with new mental health provider(s)
o Will obtain Release of information(s) (ROI) from parent/legal guardian in order to provider verbal
or written hand-off (i.e. to patient school/PCP/new mental health provider(s).
o If the transition plan is that pt. will see a CCHMC provider Bridge Therapist will complete referral
in EPIC and indicate reason for referral and who patient is to be scheduled or they can be
scheduled with anyone. This can be done with Intake Coordinator when with family or Intake
Coordinator can call family to schedule appointment.
o When pt. has a Bridge prescriber they will be included with regards to transition plan/handoff so
prescriber can also encourage/remind parent about the plan and the need to establish on going
mental health services.
o Bridge Therapist will conduct follow up calls to family PRN and if barriers persist. Therapist can
reach out to Bridge Intake Coordinator for additional support and follow up calls.

Bridge Clinic Prescriber:
 Communicate with Bridge therapist (if needed) prior to initial prescriber appointment.
 Reinforce with family that Bridge services are time limited and that patient may only have 1- 3 appts
with prescriber and that the Bridge team (Therapist, prescriber and intake coordinators) will support pts
transition services.
 Inquirer regarding parent’s efforts to contact resources to establish outpatient mental health services. If
family requires more resources provide or direct them to PIRC intake coordinators for additional
information.

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 Complete all required EPIC documentation.
 Communicate via EPIC inbox update, next appt etc…to Bridge therapist (can route completed note.)
 While patient is engaged in Bridge Clinic services ongoing communication will occur via EPIC inbox “P

PSY Bridge Clinic (11284)” with pts Bridge team (i.e. Bridge prescriber/Bridge intake coordinators) so
team is informed about next steps, transition planning etc.…
 If barriers persist with regards to transition plan, Bridge prescriber can reach out to Bridge Intake
Coordinator for additional support and follow up calls.

Transition
 If transition plan is that patient’s medication will be managed by PCP then prescriber can provide

handoff to PCP. Notify Bridge Therapist that his is part of pts transition plan.
 If transition plan is that pt. will remain as an ongoing pt. with Bridge prescriber notify Bridge Therapist

that this is part of pts transition plan.
 If the transition plan is that pt. will see a CCHMC provider, Bridge prescriber will complete referral in

EPIC and indicate reason for referral and who patient is to be scheduled with or they can be scheduled
with anyone. This can be done with Intake Coordinator when family/patient is present during appt or
Intake Coordinator can call family to schedule appointment.

Bridge Intake Coordinator:

 Triage all Bridge referrals to ensure they meet criteria. This includes Bridge referrals for CCC and for
Bridge SW/CC appointments.

 PIRC ED clinician may call while in ED with patient to schedule initial Bridge clinic appointment. Review
case with PIRC ED clinician to ensure patient meets criteria. PIRC ED clinician is responsible to
complete the Bridge referral.

 Calling on the Bridge SW/CC referrals: There will be 3 attempts to schedule Bridge appointment. Bridge
intake will call every other day and document attempt in the referral and will document in a Telephone
Encounter utilizing Bridge CCC as the reason type for phone call. (This is for tracking purposes).

 Bridge intake coordinator will also document necessary information on Bridge Tracking Spreadsheet
located at: G:\PIRC PRACTICE\Clinical Procedures\Bridge Clinic;

 This is the visit type for Bridge SW/CC initial and follow up appointments: PSY*** SW CC Bridge
(23888).

 Utilize this visit type when scheduling for a Bridge prescriber: PSY**NV APN/MD BRIDGE (23889).
Utilize 23940 when scheduling a follow-up Bridge Prescriber appt PSY**FU APN/MD BRIDGE. (FYI -
This is typically scheduled by the ASR after the initial appointment.

Bridge CCC procedures:



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“Crisis Management Plan” Guideline

1.0 Scope
These guidelines are meant to assist PIRC staff in completing the “Crisis Management Plan”

form with patients and families in the ED, Bridge appointments, and CCHMC outpatient providers. The

document was purposely designed to simplify previous crisis plans and provide families with something in

hand as they leave the ED or other appointment.

2.0 DEFINITION
Crisis Management Plan: document that outlines the processes a patient and family will use to respond to a
crisis that has the potential to cause disruption in the patients functioning and increase risk to themselves
or others.

3.0 Guidelines

3.1. When the recommendation is for discharge from CCHMC ED’s and PIRC Bridge Clinic, the PIRC staff will
complete with patients and families the Crisis Management Plan.

3.2. PIRC staff will introduce and explain the purpose of the CMP and request patient and family complete the
document together. While some families will be able to complete the form themselves, other may need some
guidance.

3.3. PIRC staff will review the completed document with patient/family.

3.4. PIRC staff will give a copy to the patient/family and retain the original document. The original document will be
kept with the patient chart so it can be scanned into the patient’s medical record.

3.5. There may be some patients/families who have had multiple admissions to CCHMC and have an effective crisis
plan in place with their current provider. In these cases, the PIRC staff will document in their note CMP not
completed as they have an effective plan already in place.

3.6. A family member may refuse to complete the CMP because they are unhappy with the disposition. The PIRC
staff will explain the importance of the CMP and encourage family/patient participate in the completion.
PIRC staff will document they recommended safety measures in the home, but the family refused to formally
complete the CMP.

BRIDGE REFERRALS: For all patients who are being referred to the Bridge Clinic, a copy of the CMP must
be faxed/scanned to Base PIRC. The original will remain with the chart.

3.7. PIRC staff will review the media tab for patients who have returned to the ED to access the previous CMP
document. PIRC staff will print the previous document for review and updating.

4.0 PIRC staff may provide other documents, Knowing Notes and pamphlets relating to crisis management and
coping skills as appropriate

5.0. Below are the expectations for each section in the CMP:
5.1. Making My Home Safe: This section was switched to checkboxes to help simplify for families and

provide a clear list of items to be locked up. Additional lines provided for any specific needs that a

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patient may have.

5.2. Knowing When I Need Help: Ideally this section will be completed by the patient and they will write
down what occurs in their body and in their thoughts and feelings right before crisis starts. It may be
helpful to ask the patient to think back to the most recent crisis and try to recall what specific thoughts
occurred and what feelings they noticed in their body. Parents should assist and provide answers if
patients are unable to complete this section. Examples of “Physical (Body)” include: stomach ache,
head ache, clenching fists, crying, yelling, hitting, etc… Examples of “Thoughts & Feelings” include: I
wish I were dead, no one loves me, no one cares what I do; so why should I, etc…

5.3. Coping Skills and Problem Solving: This section has two parts. The first section should be completed by
the patient when they are able. This is where coping skills can be listed. The second section is for
parents to complete. Parents can be of great help to patients when they are in crisis and this section is to
help parent see what their role could be. Examples are provided on the form for both sections, but ideally
the more individualized this sections is the more help it will be.

5.4. Family/Friend Supports: This can be a list of people that either the patient or adult can call when patient is
in crisis. The more specific the better. This sections is designed to be for natural supports.

5.5. Community Supports: This should be patient outpatient providers, school professionals, or other who
have a more formal role in patients’ lives. The check boxes in this section replace the signature lines and
instead provided actions steps that that patient and family can do with this “Crisis Management Plan”
from. While ideally all of this boxes being check is best, they are optional. For example, some patient’s
will have a close knit support system at school and would choose to share this. For others, this could be
an unwanted stressor. Allow the family/ patient to choose whether they want to review this plan in other
settings.

6.0 ADDITIONAL COMMUNITY RESOURCES

This sections provides family with a variety of emergency supports if their plan is not helping to resolve the crisis. Check
boxes are to the left of the name of the crisis agency. Some additional info on the crisis numbers.

Hamilton Co. Mobile Crisis – This is actually UC Health Mobile Crisis Team. If this number is not answered a family can
leave a message and will be called back. This can occur Monday through Friday 8:30am to 5:00pm. On evenings or
weekends the family will be given another number 584-8577 and told to ask for mobile crisis to be paged.

Butler Co. Mobile Crisis – number is 844-427-4747 not what is listed on the sheet currently. The can talk to a family or
individual in crisis who lives in Butler County. They may send out a mobile crisis worker if appropriate. They can also help
with referrals for mental health and substance abuse issues.

Montgomery Co. Mobile Crisis – The County contracts with Samaritan Behavioral Health. They have a crisis line for
anyone to call. They can send out a Mobile Crisis team if appropriate. They can also schedule follow up crisis walk in
appointments the next day. If patient in ED is appropriate for discharge but needs follow up the next day, CCHMC staff
can call Montgomery Co. Crisis line and they will schedule with us for the family to be seen the next day. The crisis line
can refer callers to Samaritan Behavioral mental health and substance abuse treatment if appropriate.

Clermont Co. Mobile Crisis – This is run by Child Focus. During are only open 8am to 10pm on weekday, weekends noon
to 8pm. They can be used for crisis and will talk to patients and families. They will determine if mobile crisis should be
sent out. They can only give referrals for Clermont County residents. They can do follow up phone calls with those who
call in.

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Warren Co. and Clinton County Mobile Crisis – This line is run 24/7 by the Warren and Clinton County Mental Health
Board. If a caller needs Mobile Crisis, they would call 911 and authorities would send Mobile Crisis out to either Warren
or Clinton County residents. This line provides crisis support as well as resources for mental health and other necessities.
If a caller from another county calls, they will do their best to assist in crisis situations and will work to contact other area
dispatchers as needed.
Talbert House Care Crisis Hotline – This line is run by Talbert House 24/7 and is they are there to listen to families and
patients. The person I spoke to said that people don’t have to wait until they are in a major crisis. They can complete a
lethality assessment. They can call police or Hamilton County Mobile Crisis. They can provide resources both to Talbert
House and other providers. They also have a text line TALBERT to 839-836 (TEXT ME
NorthKey Community Crisis Line – This line is run by North Key 24/7. They will assist with Mobile Crisis for Northern
Kentucky (Boone, Kenton, Campbell, Pendleton, Owen, Carroll, Grant). Calls will be answered for any caller despite
location, but if outside of Northern Kentucky, they will be referred to other county hotlines. Callers will be triaged by the
answering service and they will be transferred to a crisis therapist if appropriate. That therapist can assist caller in
obtaining needed mental health services through NorthKey or they would recommend they go to the ED if needed.

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How to refer and schedule patient into Bridge Clinic

 PIRC clinician utilizes Bridge Clinic criteria to identify patients for program
 PIRC clinician completes Crisis Management Plan with patient and family
 PIRC clinician makes referral or provides resources to patient and family for on-going mental

health services.
 PIRC clinician completes referral for Bridge Clinic in EPIC specifying type of service in Reason box:

Bridge SW/CC or Bridge CCC. Document reason for referral and resources provided etc.. in the
notes tab in the referral. SEE JOB AID on page (?).
 If Intake Coordinator is available, the appointment will be scheduled and written on patients Crisis
Management Plan prior to discharge. If after hours, patient and family informed by PIRC Clinician
that they will receive a call tomorrow from Psychiatry Intake to schedule the Bridge appointment
 PIRC clinician puts ED sticker on original copy of Crisis Management plan
 PIRC clinician makes copy of Crisis Management Plan for family so they have copy at discharge
and places additional copy in Bridge mailbox in PIRC office at Base and at Liberty.
 PIRC clinician will put original Crisis Management Plan in ED chart and it will be scanned into
patient’s EPIC chart under the media tab.

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Pathway to providing resources to Bridge referred patients/families: A team process from
beginning to end.

At every touch point/contact either via phone or face/face take a moment to remind family/legal
guardian about establishing on-going mental health services for patient.
Criteria/expectation: Parent/caregiver should be an active and engaged team member in the
treatment process which includes the transition plan which requires them to actively seek a
mental health provider for the patient.

PIRC Clinician in the ED: Pt referred to Bridge for CCC or SW/CC:
 resources are provided to the family;
 The agency names are documented in the PIRC note in EPIC.
 This allows for the next staff member to be informed and if additional resources are requested duplication
is avoided.

Intake Coordinator reviews referral and contacts family for either CCC or to schedule initial Bridge appt if
SW/CC:

 Intake inquires if family has reached out to resources provided in ED to initiate ongoing mental health
services.
o Encourages parent to do so;
o Provides additional resources, if needed and documents in EPIC
o Identifies any potential barriers; documents in EPIC.
o Schedules Bridge appt SW/CC and email’s appt to Connie and Cheryl – for tracking purposes.

Initial Bridge Clinic appointment:
 Bridge Clinician will inquire if family has called upon given resources and if any appointments have been
established. This will be documented in EPIC.
 2nd Bridge appt Bridge Clinician provides reminder about status of contacting provided resources to
establish mental health services.
 3rd Bridge appt and no progress in establishing services Bridge clinician will reach out to Bridge intake for
support: Intake can make additional phone calls to family; help determine if CPST is needed if pt has
Medicaid; offer to place referral for family; support family with any barriers they may encounter especially
if they are the barrier.

If patient cancels or is a no show for initial Appointment Bridge Intake coordinators will be notified.
 Intake will reach out to family to determine if reschedule is needed and inquire if they have established
mental health services;
 Intake will re-schedule if needed with parent/caregiver
 Encourages parent/caregiver to call resources;
 Provides additional resources, if needed and document those in EPIC
 Identifies any potential barriers; document those in EPIC.

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If patient is an established Bridge pt and they cancel or no show the Bridge Clinician will:
 reach out to family to determine if reschedule is needed and inquire if they have established mental health
services;
 If re-schedule needed Bridge clinician will contact Intake to book appointment.
 Encourages parent/caregiver to call resources;
 Provides additional resources, if needed and document those in EPIC
 Identifies any potential barriers; document those in EPIC.

After 2 no show appts the referral will be closed. After 2 cancelations referral will be closed.
PARENT/LEGAL GUARDIAN

BRIDGE
INTAKE
ED

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Bridge Clinic Clinician Appointment Workflow
Initial Bridge Clinic Appointment:

 Scheduled PSY** SW CC Bridge
 Bridge Clinic patients will be seen at either Location E (Room 2.222 and 2.***) for Base and 2nd Floor

Psychiatry (Room 113) for Liberty
 Patients will be checked in by Psychiatry ASR staff upon arrival
 Bridge clinician will utilize Bridge Clinic progress note (.phrase = .pircbridge)
 Bridge clinician will utilize completed PIRC Crisis Management Plan from ED PIRC assessment and will

review and update with patient and family, as needed. Any changes must be documented and given to the
family and documented in that appointment’s Bridge Clinic progress note.
 Charge Capture (billing for services) – Initial crisis appointment:

o 90839 is used for the first 30-74 minutes of psychotherapy for crisis intervention
o 90840 is used to report any additional blocks of time, of up to 30 minutes each, beyond the first 74

minutes used

Follow-up Bridge Clinic Appointment:
 Scheduled PSY** SW CC Bridge
 Bridge Clinic patients will be seen at either Location E (Room 2.222 and 2.***) for Base and 2nd Floor
Psychiatry (Room 113) for Liberty
 Patients will be checked in by Psychiatry ASR staff upon arrival
 Bridge clinician will utilize Bridge Clinic progress note (.phrase = .pircbridge)
 Bridge clinician will utilize completed PIRC Crisis Management Plan from ED PIRC assessment and will
review and update with patient and family, as needed. Any changes must be documented and given to the
family and documented in that appointment’s Bridge Clinic progress note.
 Charge Capture (billing for services) – Follow-up crisis appointment:
o 90837 Psychotherapy, 60 minutes with patient and/or family
o 90834 Psychotherapy, 45 minutes with patient and/or family (UHC/UBH patient can utilize
services up to 45 minutes)
o 90832 Psychotherapy, 30 minutes with patient and/or family

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Communication is the process by which information is exchanged between individuals, groups, and

organizations.

Effective Communication Barriers to Communication

Complete Lack of time

Clear Hierarchy

Concise Defensiveness

Timely Distraction

Varying communication styles

Fatigue

Conflict

Workload

One predictable and critical communication event is the patient handoff.
Definition: A handoff may be described as the transfer of patient information and knowledge, along
with authority and responsibility, from one clinician or team of clinicians to another clinician or team of
clinicians during transitions of care across the continuum.

The handoff should include an opportunity to ask questions, clarify, and confirm the information being

transmitted. As part of its standard of provision of care, treatment, and services, The Joint Commission
requires that the “process for hand-off communication provides for the opportunity for discussion between the
giver and the receiver of patient information” (1). Consideration should be given to the implementation of a

standardized approach for handoff communication. A process for guiding the handoff process should include
the following:

 Interactive communications

 Limited interruptions
 A process for verification

 An opportunity to review any relevant historical data (2)

1. The Joint Commission. Comprehensive accreditation manual. CAMH for hospitals: the official handbook.
Oakbrook Terrace (IL): Joint Commission; 2010. ⇦

2. Agency for Healthcare Research and Quality. Patient safety primers: handoffs and sign-outs. Available
at: http://psnet.ahrq.gov/primer.aspx?primerID=9. Retrieved July 28, 2011. ⇦

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Weekly huddle for Bridge clinicians and Bridge intake coordinators:

Purpose: to develop a communication protocol in Bridge Clinic to ensure improved outcomes for
patient/family and to demonstrate accountability amongst team members.

Goal: enhance communication amongst Bridge Clinic team members;
 enhance tracking of patient’s while in the Bridge Clinic to better meet their needs in the time limited
 program;

 develop effective and standardized safe hand off procedures for patients transitioning from the Bridge
Clinic program to their newly established mental health providers.

Expectations in the huddle: Come prepared to briefly discuss Bridge patients who you have identified as:
 Ready to transition from Bridge and where they will continue their care? i.e new mental health
providers name and appt date/time; safe handoff has been provided?
 Patients who may require additional support i.e pt canceled or no show again and has not returned
clinicians call(s) in 2 - 3days.
 Should patient be scheduled wth APN/MD?
 Should a CPST referral be made?

Bridge Clinic
Huddle

Patient Identifiers - MRN, name, age, sex

Actions What has been done; what needs to be
Ownership done?

Who is responsible for what?

Next The plan?

 Intake coordinators will document information on Bridge tracking sheet.
 Intake coordinators will add identified patient(s) to their case load to increase attempts to reach family

to ascertain if pt requires another Bridge appointment or if they have established services in the
community.

Tentative Schedule:
Duration: 15 minutes, if necessary, no longer than 30 minutes

Tracking and Transition Meeting Schedule

Clinician Monday Tuesday Wednesday Thursday Friday

Tara 2:00 PM

Brett 4:30 PM

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Kathy 12:30 PM 3:00 PM
Kristi 12:30 PM
Monica
Valerie

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Making a BRIDGE referral
Step 1: From Patient Station select the Appts button. This will open the Appointment Desk for this patient.

Step 2: Select the Patient Options drop down box and scroll down to Referrals and select.

Step 3: Select the New button to create a new referral.

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Step 4: You will need to fill in the drop boxes on this screen.
1. Change the Type: section to Psychiatry.
2. In the Reasons box type Bridge and select Bridge Clinic CCC or Bridge Clinic SW/CC
3. Change Dept specialty: to Psychiatry

Step 5: Complete the Notes section on the referral indicating the following:
In Type section put General and then you can free type and or cut and paste in the notes section.

Please include the following:
1. Reason patient is referred to Bridge
2. The resources that were provided to the family to begin their search for mental health provider
3. You can copy and paste this information from your PIRC ED note if that is helfpful

Click Accept to save note and referral.

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How to view your schedule

Change EPIC context:

Liberty Providers will use “LIB Psychiatry”
Base providers will use “CCM Psychiatry”

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Click “Go to schedule”

Expand the “CCM Psychiatry” or “LIB Psychiatry” folder. Find your name and select it to view your schedule.
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Select the date to view your schedule for that date:
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Documentation Workflow
1. Chief Complaint is “Other” and Comment is “Crisis – Bridge Clinic”

2. Complete Progress Note (see next page)
3. Update Problem List (diagnosis used for psychotherapy billing)

a. Select “Add New Problem” to update the primary diagnosis for your Bridge Clinic service
4. Charge capture – billing for Bridge session

a. Select “Psychotherapy” Service
5. Sign Visit

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Bridge Clinic Progress Note (.pircbridgeclinic) **INSTRUCTIONS ARE HIGHLIGHTED**

PIRC Bridge Clinic
Progress Note

@NAME@
@DOB@
@MRN@

Met with @NAME@ in my office, on this date, beginning at *** and ending at *** for crisis stabilization and
safety planning.
Current Crisis State and Restoration of Safety:

**CLINICAL NARRATIVE**

Mental Status Examination:
Appearance: {PSY; APPEARANCE:304310004}.
Psychomotor Activity: {PSY; PSYCHOMOTOR ACTIVITY:304310005}.
Speech/Tone: {PSY; SPEECH/TONE:304310006}.
Articulation/Tone: {-:30480061}.
Mood: {MSE MOOD:30480055}.
Affect: {MSE AFFECT:30480054}.
Vegetative Signs: {MSE VEGETATIVE SIGNS:30480062}.
Thought Process: {MSE THOUGHT PROCESS:30480051}.
Abnormal/Psychotic Thought Content: {-:30480052}
Perceptions: {MSE PERCEPTIONS:30480063}.
Cognitive: {PSY; COGNITIVE:304310016}.
Attention/Concentration: {MSE ATTENTION/CONCENTRATION:30480064}.
Judgment: {MSE JUDGMENT:30480060}.
Insight: {MSE INSIGHT:30480059}.
Impulse Control: {-:304400185}

Risk Assessment:
Current Suicidal Ideation: {REPORTS/DENIES:30480330}
Current Homicidal Ideation: {REPORTS/DENIES:30480330}
Do you have thoughts to physically attack someone, causing them harm? {REPORTS/DENIES:30480330}
Does patient demonstrate behavior(s) that may indicate the potential for physically harming someone? {YES-
DESCRIBE/NO:210100032}
Do you have thoughts to physically destroy property? {REPORTS/DENIES:30480330}
Does patient demonstrate behavior(s) that may indicate the potential for destroying property? {YES-
DESCRIBE/NO:210100032}

Additional Family/Provider Collateral Clinical Information: Yes
Describe: ***

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**COMMUNICATION FROM PARENT/GUARDIAN INCLUDING ISSUES/CONCERNS, ABILITY TO ADHERE
TO SAFETY PLAN, PROGRESS CONNECTING WITH AN ONGOING PROVIDER AND HOW PT HAS BEEN
DOING SINCE ED OR LAST BRIDGE CLINIC VISIT**
Safety Plan:
Patient and parent/guardian {DO/DONOT:19853} have the ability to continue to follow established safety plan.
**NOTE ANY ADJUSTMENTS MADE TO SAFETY PLAN IF APPLICABLE**
Transition Plan Update:
Family scheduled appointment with provider? Yes/No ***
Barriers to transition? Yes/No ***
Clinician:
Return visit: Yes/No *** NEXT BRIDGE APPT
Refer to: CCC ***

APRN/MD ***
CPST ***
**YES OR NO RESPONSE AND ANY UPCOMING APPT**
Close: Yes/No **PT BEING DISCHARGED FROM BRIDGE?**
Disposition: {PLAN; PIRC DISPOSITION:304610227}
**PLAN FOR TODAY’S VISIT**

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