Clinical Forms
In support of our commitment to quality care, we require our providers to maintain organized, well-documented member treatment records that reflect continuity of care. We expect all aspects of treatment will be documented in a timely manner, including face-to-face encounters, telephone contacts, clinical findings and interventions.
This page includes sample and actual forms Magellan uses or requires in the member’s medical record. Where indicated, forms may be printed and photocopied as needed for the Magellan members in your care.
NOTE: Forms marked “SAMPLE” may not be compliant with some state regulations. It is the provider's responsibility to ensure that his/her documentation is compliant with all applicable state laws.
Treatment
Record Review Form 
(PDF,
180K)
The Treatment Record Review (TRR) form is not required in the member's file. This form is for reference purposes and is used by Magellan reviewers when evaluating treatment records during a site visit. For more information on TRR and site visits, please see the Magellan Provider Handbook.
Authorization
to Disclose to PCP Form (PDF
77K)
This is a sample of a form that enables the behavioral health provider to share protected health information (PHI) with the primary care physician (PCP). The provider is encouraged to have each member sign and date the form at the outset of new episodes of care.
Clinician Communication
Form (PDF
26K)
A completed Clinician Communication Form allows the behavioral health provider to inform the PCP that behavioral health treatment is occurring, and also provides information on how to contact the behavioral health provider if needed. Other information in the communication can include member diagnosis, a clinical summary, treatment plan changes, member safety issues, laboratory tests ordered, and medication issues or changes.
Psychological
Testing (PDF
148K)
Psychological
Testing Instructions (PDF
131K)
This form is to be completed when authorization for psychological testing is being requested. In most cases, an initial assessment by a behavioral health care provider must be administered before psychological testing will be authorized. To avoid potential issues with reimbursement, psychological testing is not to be initiated until an authorization has been received.
Treatment Request Form (PDF
38K)
Treatment Request Form Instructions (PDF
38K)
We strongly encourage you to submit treatment request forms (TRFs) to Magellan using our secure, Internet-based TRF (After signing in, choose “Get More Outpatient Authorizations” from the “Providing Care” top-menu item). Most providers use this method to submit TRFs due to the ease of transmission and rapid response. However, since some providers still prefer to submit paper TRFs by fax, we want to provide a form that you may print out as well. You can use this TRF for most members treated; but, there are some exceptions to using the form, which are listed on this website.
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