Serious Mental Illness (SMI)
Submission Forms & Checklist
Solari is committed to making well-informed, accurate, and timely determinations, maintaining fidelity of criteria, and collaborating with providers to make this process as transparent as possible.
SMI consent for assessment (required)
This must be signed and dated within one (1) business day of submission of application to Solari. The assessment cannot be processed without this form signed and dated appropriately.
*Please submit court documents for cases when applicants are COT and do not consent, if there is a legal guardian of an adult, if the Health Care Decision Maker (HCDM) for a child is someone other than their parent or if a parental custody decree is on file outlining who can consent for children of divorce.
Seriously Mentally Ill (SMI) Determination Form (required)
This form must be signed by a licensed clinician; the assessment cannot be processed without this form signed and dated appropriately.
Core assessment (required)
This must be a state approved core assessment dated within six (6) months of the submission.
Waiver of Three (3) Day Determination form
Please note that applicants are encouraged to waive their right to a three-day determination. Generally speaking, evidence suggests that additional time to review and pursue historical treatment records result in a positive outcome.
If this form is not submitted, the determination will be made in three days.
Demographic form
This form is helpful as a coversheet or a checklist to ensure all necessary information is collected regarding applicants’ demographics.
Releases of Information
It is helpful to have an ROI that includes any current or prior outpatient and inpatient providers, jails, schools, as well as any emergency contact or family members. There should be a ROI for any records the applicant would like considered as part of the determination process.
Removal of Designation form
This attestation form takes the place of the consent form in an initial determination packet.