Clinician
portal
general clinician NEEDS
This form allows you to submit requests for time off and should be submitted 6-weeks in advance of intended days off.
This form allows you to notify Change, Inc. that you’d like more clients added to your weekly roster no more than every 8-12 weeks.
This form allows you to help expand Change, Inc.’s in-house list of referrals and resources which we use to help clients meet their needs in the community (used in particular by the CLT and CD/Transition-Triage team). You should use this form if you have a referral or resource you’d like us to consider adding to that list for any need you anticipate our clients may have (mental health, medical, wellness, financial, advocacy, etc.)
This form allows you to submit a Job Candidate Referral to Change, Inc. This is the only way to become eligible for any current hiring bonuses, and it should be submitted after you’ve let the Job Candidate Referral know you will be contacting us/they’ve consented to being referred. NOTE: Job Candidates who have already engaged our hiring process cannot be referred for bonus eligibility.
This form allows you to submit a report to Change, Inc. about any incident you may have encountered in our environment that violates company policy, protocol, or had an otherwise negative impact. You should use this form if there is something you need to report of this type to the Managing Director.
This form allows you to update your personnel information with Change, Inc. You should use this to let us know about changes to your name, address, phone number, counseling licensure, gender identity, and more.
facilities/maintenance Needs
This form allows you to notify the Managing Director of an issue or request surrounding maintenance or facilities issues. You should use this form if something is broken or otherwise amiss with our physical work space, or if you’d simply like to ask for something related to facilities that may improve your work experience.
BILLING MANAGED CARE NEEDS
This form allows you to submit the required information for billing after an intake session for a client who is billed through insurance. You should complete this form within 24 hours of an Initial Session (90791) with an insurance client, or after the first insurance-billed session for a client who transitioned from paying cash to using insurance.
This form allows you to submit a CPT code and diagnosis for each regular (i.e., non-initial) session you have with any insurance-based client. You should complete this form on the same day as any insurance-based session.
supervision and check-ins
This is not a form, just a link to the .PDF of the Supervision Record new/provisionally-licensed or otherwise-directed clinicians should use to record in written form the contents of their supervision records. These must be completed during the supervision session, and given to the supervisor thereafter within 24 hours for their signature. It is also available at the Change, Inc. Google Drive at Drive>Staff/Therapist Needs>Forms/Tools.
This form allows you to evaluate your experiences at Change, Inc. as they relate to supervision and should to be completed at the end of every supervision session.
transition/triage and resource coordination
This form allows you to notify the Clinical Direction team when a client needs resources (e.g., Psychiatric care, classes/groups, etc.) from an ACD who maintains our master resource list. Please complete this form (rather than emailing an ACD) whenever a client need becomes apparent.
This form allows you to notify the Clinical Direction team when a client needs or wants to meet with an ACD for a Transition/Triage Session for the possibility of being referred to different level of care (etc.). Please complete as soon as you’re ready to initiate a Transition/Triage Process.
CLIENT-RELATeD FORMS AND PARENT SESSIONS
This form allows you to send clients Insurance Reimbursement Documentation, and replaces our old method of simply emailing it to them. When you fill out this form, it sends the client an email with the date they requested the IRD, the date they’re receiving it, a way to reply directly which goes to CLT, your email address, and links to the ICA and the client portal. It also securely pends a copy of the IRD for easy access by the CLT so they don’t have to ask you for it should the client write in and ask for it again! Please complete this form and attach the IRD within 30-days of client request, and be sure to upload the IRD .pdf to the correct client file on google drive.
This form allows you to send clients letters they have requested, and replaces our old method of simply emailing it to them. When you fill out this form, it sends the client an email with the date they requested the letter, the date they’re receiving it, a way to reply directly which goes to CLT, your email address, and links to the ICA and the client portal. It also securely pends a copy of the letter for easy access by the CLT so they don’t have to ask you for it should the client write in and ask for it again! Please complete this form and attach the letter within whatever reasonable time frame that corresponds to the client request may be, and be sure to upload the letter .pdf to the correct client file on google drive.
This form allows you to notify Change, Inc. when you have terminated therapy with a client, defined as client and having had a termination session, the client reached desired therapy outcomes, and the closing out was generally positive and upbeat as it regarded the work you’d done together. Please complete this within 3-4 days of your termination session with a client.
This form allows you to submit information about an Adolescent Client to the appropriate Parent Session Clinician, prior to a parent session. It should be submitted approximately 7-10 days in advance of evert scheduled parent session date.
This form allows you to submit information about your most recent Parent Session to the appropriate Adolescent Clinician. It should be submitted within 24 hours after the most recent parent session that has taken place.
PEer to peer training
This form allows you to submit a presentation for Change, Inc.’s Monthly Peer to Peer Training program. Use it any time you’ve got a topic you’d like to present to the entire team for which you have expertise/training/experience. The Clinical Direction team will review it within 5-7 business days.
continuing education
This form allows you to submit a request to enact your contract/otherwise provided Change, Inc.-provided half-cost benefit for Continuing Education opportunities and should be completed in advance of enrolling.
This form must be submitted within 1 week of completing a Change, Inc.-approved, half-cost benefit provided Continuing Education Opportunity. Please also be sure to upload any presentations, handouts, etc. to Google Drive.
This form allows you to take the quiz for the Change, Inc. 101 Workshop listed, as well as to complete the attestation. It should be used after watching the listed workshop.
FUN COMMITTEE
This form allows you to RSVP to upcoming FUN Committee Events! It should be used any time you’d like to indicate that you are attending/not attending any such event.