8.4 Clinical Reviews


During a prospective review, services are reviewed before they are authorized to determine if the participant, the current processes, or both were followed.

The purpose is to ensure that:

  • a participant meets eligibility requirements;
  • services will meet the participant’s needs; and
  • CRS program staff members are following CRS policies and procedures.

The review may include:

  • a review of intake and assessment information;
  • a diagnostic interview;
  • a review of the participant’s records that support eligible diagnosis or diagnoses;
  • a determination of eligibility by the CRS counselor;
  • a review of the participant’s Individualized Written Rehabilitation Plan;
  • a review of the participant’s records documenting the care of the participant provided by the provider, paraprofessionals and professionals;
  • medical and nursing assessment and diagnoses;
  • changes in treatment strategies based on data or assessments;
  • a review of the interdisciplinary team meeting summaries;
  • participant schedules;
  • a review of the consents from the participant;
  • a review of the participant restraints reports;
  • on-site visits and outings;
  • assessments made at the request of or by the CRS counselor;
  • interviews held with the participant, participant’s family or guardian; and
  • discharge planning.