TMPPM 2010 > Behavioral Health, Rehabilitation, and Case Management Services Handbook > Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), and Licensed Professional Counselor (LPC) > Services/Benefits, Limitations, and Prior Authorization > Prior Authorization > Initial Prior Authorization Request for Encounters/Visits beyond the 30-Encounter/Visit Limit

5.2.1.1.2 Initial Assessment Requirements

There must be a pertinent history containing the following assessment requirements:

•A chronological psychiatric, medical and substance use history with time frames of prior treatment and the outcomes of that treatment

•A social and family history

•An educational and occupational history