How to complete a Client Acknowledgement/Consent to Treatment/Services form n Evolv

his article explains how to complete the Client Acknowledgement/Consent to Treatment/Services form in Evolv:

The Client Acknowledgement/Consent to Treatment/Services - Is used for obtaining authorization from client/guardian to obtain services and treatments from Child & Family Services, Inc. for the following programs:

• Adoption - Family Resource
• _{Adoption Journeys}
• _{Adult Community Crisis Stabilization (ACCS)} 
• _{Adult Mobile Crisis Intervention (AMCI)}
•  _{Caring Network} 
• _{Certified Community Behavioral Health Ctr (CCBHC)}
• _{Community Service Agency-Day Rate}
• _{Community Service Agency-Family Support & Training} 
• _{Empowering Families for Success (est. 2019)}
• _{In Home Therapy}
• _{Mental Health Clinic}
• _{Parent Mentor} 
• _{Parents as Teachers}
• _{School Based Targeted Intervention Program}
• _{Therapeutic Mentoring} 
• _{True Course Program (TCP)}
  
• _{Young Adult Access Center Program (YAAC)} 
• _{Young Parent Support} 
• Youth Community Crisis Stabilization (YCCS)
• Youth Mobile Crisis Intervention (YMCI) 

Important Notes:

• Please read through all important information before continuing with this article 
• Be sure to follow all steps as written below. If there are any issues with this article, please report them to the IT Department immediately for corrections and additions.
• Client Acknowledgement/Consent to Treatment/Services form can be found in either:
  • Client > Client Information > Personal Information > Requirements
    
  • Client > Case Management > Service Management > Service Entry
    • Most programs have the Client Acknowledgment/Consent to Treatment/Services auto scheduled.  
      • If event has been auto scheduled, complete auto scheduled task instead of creating a new event.
• Client Acknowledgment/Consent to Treatment/Services forms should be completed together with client/guardian.
• All fields marked with an asterisk *, must be completed before the final "Save."
• Client/guardian should only sign completed Client Acknowledgment/Consent to Treatment/Services form (never a blank form)
• Client signatures should be captured within the Evolv form unless client is not accessible in which Drop Box (formerly HelloSign) maybe be used.
• Once Client Acknowledgment/Consent to Treatment/Services form is completed and signed by client/guardian, form should be e-signed by worker completing event.

Important information from the VP of Quality:

• This new (2023) universal consent form will encompass agency-wide expected acknowledgements and consents, as well as a section with "Program Specific" forms/consents.
• Please be mindful of the labels to determine whether or not your program needs to complete that section.
• Please note that a newly revised Agency "Notice of Rights and Responsibilities" is available in this new form; this newly revised version has both the Notice of Client Rights and the Client Responsibilities, as well as our Grievance Policy embedded all together; these forms have also been translated into Portuguese and Spanish.
• We realize that this will be a change for some staff, as some of the sections were not in some of the program's previous forms, however we ask that you review all the "agency-wide" acknowledgements and consents and ask the clients to either "agree" or "refuse" to give consent.
• In most cases the hope is that a client consents (even if it isn't relevant to them at the moment, however it may be relevant in the course of the treatment, and it would be best to have the consent on file- i.e. consent to client record photographs (not all programs are doing this yet, however there will be a push in the future to get this up and running so that we have a picture of every client that lives in their medical record); Also, consent for group/telehealth for group- it may not apply right now, however in the event that a client wants to engage in a group they would have this consent already on file and would not need to create a new one, etc. ; Consent for Epi-pen is one that was only on certain program's forms, however it will be expected that every client has this filled out. Simply ask if this applies to the client (any allergies that can result in anaphylaxis) and if it doesn't apply to them... then you can simply check refuse. 
• We discontinued the N/A for these forms and are simply asking if it isn't applicable that you explain to the client that we'll just have them "refuse" the consent. 
• General reminder to all staff-: client ack/consent to treatment forms MUST be completed annually; failure of a client to complete annual consents will result in termination from services. As an agency, we cannot be actively "treating" clients without updated consents due to the risk and liability associated with this.

Instructions:

Client Acknowledgement/Consent to Treatment/Services

used for obtaining authorization from client/guardian to obtain services and treatments from Child & Family Services, Inc.

Create or open scheduled event.

Complete Fields:

1. ALL CFS Programs:
   1. CONSENT TO TREATMENT/SERVICES
      1. I understand that these services may be provided in the* - Check all options where services is/will be provided (Office/Home/Community)
      2. Consent for Treatment/Services* - select client's response from Agree/Refuse to Consent table
         1. Exceptions to Consent for Treatment/Services* - must be explained if client's response was "Agree with Exceptions
   2. CONSENT FOR TELEHEALTH
      1. Consent for Telehealth forms* 
         1. Click on Globe to launch to Consent for Telehealth form
         2. Select appropriate form
         3. Review form with client/guardian
         4. Print form for client (unless client refuses copy)
         5. Close Consent for Telehealth form
      2. Consent for Telehealth* - select client's response from Agree/Refuse to Consent table
      3. Exceptions for Telehealth* - required field if client's response was "Agree with Exceptions".  Enter specific exceptions stated by client.
   3. CONSENT FOR GROUP TREATMENT/SERVICES 
      1. Consent for Group Treatment/Services - Review statement with client ("In order for members.......I may be receiving")
      2. Consent for Group Treatment/Services* - select client's response from Agree/Refuse to Consent table.
      3. Exceptions for Group Treatment/Services* - required field if client's response to Group Treatment/Services was "Agree with Exceptions". Enter specific exceptions stated by client.
   4. CONSENT FOR GROUP TELEHEALTH
      1. Consent for Telehealth for Groups forms* 
         1. Click on Globe to launch to Consent for Telehealth for Groups form
         2. Select appropriate form
         3. Review form with client/guardian
         4. Print form for client (unless client refuses copy)
         5. Close Consent for Telehealth for Group form
      2. Consent for Telehealth for Groups* - select client's response from Agree/Refuse to Consent table
      3. Exceptions for Group Telehealth* - required field if client's response was "Agree with Exceptions".  Enter specific exceptions stated by client.
   5. CONSENT FOR RECORD PHOTOGRAPH
      1. Consent for Record Photograph - Review statement with client ("I consent that.......mental health record")
      2. Consent for Record Photograph * - select client's response from Agree/Refuse to Consent table.
      3. Exceptions for Record Photograph * - required field if client's response was "Agree with Exceptions". Enter specific exceptions stated by client.
   6. CONSENT FOR PHOTOGRAPH/VIDEO/AUDIO RECORDING
      1. Consent for Photograph/Video/Audio Recording - Review statement with client ("I consent to.......property of Child & Family")
      2. Consent for Photograph/Video/Audio Recording* - select client's response from Agree/Refuse to Consent table.
         
   7. CONSENT FOR TRANSPORTATION
      1. Consent for Transportation - Review statement with client ("I consent.......is their care")
      2. Consent for Transportation* - select client's response from Agree/Refuse to Consent table.
      3. Exceptions for Transportation* - required field if client's response was "Agree with Exceptions". Enter specific exceptions stated by client.
   8. CONSENT FOR EPIPEN
      1. Consent for EpiPen - Review statement with client ("I consent.......said procedure")
      2. Consent for EpiPen* - select client's response from Agree/Refuse to Consent table.
      3. Exceptions for EpiPen * - required field if client's response was "Agree with Exceptions". Enter specific exceptions stated by client.
   9. CONSENT FOR ACCESSING EMERGENCY MEDICAL CARE
      1. Consent for Accessing Emergency Medical Care - Review statement with client ("I consent.......and activities")
      2. Consent for Accessing Emergency Medical Care* - select client's response from Agree/Refuse to Consent table.
      3. Exceptions for Accessing Emergency Medical Care* - required field if client's response was "Agree with Exceptions". Enter specific exceptions stated by client.
   10. NOTICE OF RIGHTS AND RESPONSIBILITIES
       1. Notice of Rights and Responsibilities forms
          1. Click on Globe to launch to Notice of Rights and Responsibilities forms.
          2. Select appropriate form.
          3. Review form with client/guardian.
          4. Print form for client (unless client refuses copy).
          5. Close Notice of Rights and Responsibilities form.
       2. Notice of Rights and Responsibilities* - check this box to verify that the form was reviewed with the client.
       3. Client declined a copy of Notice of Rights and Responsibilities - check this box if client refused a copy of the form.
   11. PRIVACY NOTICE
       1. Privacy Notice 
          1. Click on Globe to launch to Privacy Notice forms.
          2. Select appropriate form.
          3. Review form with client/guardian.
          4. Print form for client (unless client refuses copy).
          5. Close Privacy Notice form.
       2. Privacy Notice* - check this box to verify that the form was reviewed with the client.
       3. Client declined a copy of Privacy Notice - check this box if client refused a copy of the form.
   12. ELECTRONIC SHARING OF HEALTH INFORMATION
       1. Electronic Sharing of Health Information HIE 
          1. Click on Globe to launch to Electronic Sharing of HIE form.
          2. Select appropriate form.
          3. Review form with client/guardian.
          4. Print form for client (unless client refuses copy).
          5. Close Electronic Sharing of Health Information form.
       2. Electronic Sharing of HIE * - check this box to verify that the form was reviewed with the client.
       3. Client declined a copy of Electronic Sharing of HIE  - check this box if client refused a copy of the form.
2. PROGRAM SPECIFIC ACKNOWLEDGEMENT/CONSENT FORMS:

1. APPOINTMENT and CANCELLATION POLICY
   1. Appointment and Cancellation Policy 
      1. Click on Globe to launch Appointment and Cancellation Policy forms.
      2. Select appropriate form.
      3. Review form with client/guardian.
      4. Print form for client (unless client refuses copy).
      5. Close Appointment and Cancellation Policy form.
   2. Appointment and Cancellation Policy - check this box to verify that the form was reviewed with the client.
   3. Client declined a copy of Appointment and Cancellation Policy - check this box if client refused a copy of the form.
2. HOURS OF OPERATION
   1. Hours of Operation forms- program specific form found in forms link 
      1. Click on Globe to launch Hours of Operation forms.
      2. Select appropriate form.
      3. Review form with client/guardian.
      4. Print form for client (unless client refuses copy).
      5. Close Hours of Operation forms.
   2. Hours of Operation - check this box to verify that the form was reviewed with the client.
   3. Client declined a copy of Hours of Operation - check this box if client refused a copy of the form.
3. PLACEMENT AGREEMENT / WAIVER OF LIABILITY  

1. Placement Agreement Forms
   1. Click on each Globe to launch Placement Agreement forms.
   2. Select appropriate form.
   3. Review form with client/guardian.
   4. Print form for client (unless client refuses copy).
   5. Close Placement Agreement forms.
2. Waiver of Liability  
   1. Click on each Globe to launch Waiver of Liability forms.
   2. Select appropriate form.
   3. Review form with client/guardian.
   4. Print form for client (unless client refuses copy).
   5. Close Placement Agreement forms.
3. Placement Agreement - check this box to verify that the form was reviewed with the client.
4. Client declined a copy of the Placement Agreement form - check this box if client refused a copy of the form.
5. Waiver of Liability - check this box to verify that the form was reviewed with the client.
6. Client declined a copy of the Waiver of Liability - check this box if client refused a copy of the form.