Date of Discharge:
Date of last successful bidirectional contact:
Modality of last successful bidirectional contact:
Reason for Discharge: Premature Contact Drop Off
Was the member in agreement with termination at this time? N/A - Member stopped engaging with Care Team despite continuous outreach from peer and therapist for 90 days.
If member did not return for scheduled appointment, list date of most recent attempt(s) made to contact member to reschedule:
Narrative Summary of Relevant Clinical Factors at time of Discharge:
Member did not consistently engage with Care Team for 90 days despite repeated outreach by peer and therapist each week. Attempts were made via phone and text for the past 90 days without a substantive response and a member no showed appointment(s). As such, member will be discharged per current guidelines.
Final DSM 5 Diagnoses:
Signature: