Recording PMHC
To record PMHC encounters so that the data can be used in the PMHC MDS, use PMHC-specific clinical items.
Use the following clinical items for primary mental health contacts. These are included in the PMHC MDS and can usually be found on a button in the clinical record labelled PMHC.
- PMHC Episode Start - this must be completed at the start of
any new episode (a series of contacts over a period of time related to the same
mental health issues). Ensure that you include intake context:
- Intake and treatment Episode
- Intake Only Episode - also record the referred to organisation path
- Treatment Only Episode - also record the intake organisation path
- PMHS Service Contact - this must be completed every time the client attends during the ongoing episode. This cannot be added until there is an episode start and not after an episode end.
- PMHC Episode End - this must be completed at the same time as the final service contact for the ongoing episode when the episode is deemed to be over.
- PMHC Client (optional) – captures information relating to the client that is not currently recorded in the patient biographics.
To record primary mental health contacts:
- Ensure that the client’s biographic details, including languages spoken, are up-to-date. Use PMHC Client to capture any additional client information that is not included in the patient biographics.
- At the start of an episode, add both PMHC Episode Start and PMHS Service Contact to the patient's clinical record and address every qualifier if possible. You cannot record a service contact if there is no open episode, that is, an episode that has been started but not yet ended.
- At every subsequent contact, add PMHS Service Contact to the patient's clinical record and address every qualifier if possible.
- When you deem that the episode is over, complete both PMHS Service Contact and PMHC Episode End.
Tip: You cannot add
activity items until after a patient has been enrolled in a program. However,
you can still add activity items after a patient has been exited from a program.
This allows for genuine backdating of clinical items. For example:
- If you are using an offline client and your clinical program enrolments and exits have got out of step, you can backdate an exit.
- If items are out of sequence, correct the items.
- For a patient who exited last week, record an action from two weeks ago.