If you are in immediate crisis and need urgent care, please go immediately to your nearest hospital emergency room or call 9-1-1.
if you need to schedule an appointment or need immediate consultation with a Matrix doctor, call Matrix at 800-886-1171.
If calling after regular business hours, the Matrix on-call doctor will be paged to return your call immediately.
Need an answer? Submit a question to a Matrix doctor and get an answer via e-mail.
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Question
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This is the EAP closure summary form.
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Client Number
Therapist
Closure Date
Date of Last Appointment
Additonal Persons Attending Sessions
Total Number of EAP Sessions
Check One No further therapy required Continuing with same doctor under insurance Referral to an outside resource
List All Names of Outside Referrals
Check All Appropriate Categories: Counselor/SW O/P Special Care Psychiatrist Hospital Financial Councelor Psychologist I/P MH Facility
Physician Self-Help Group Social Service Agency I/P Special Care Facility O/P MH Facility Community Health Agency Attorney Other
Outcome Evaluation: Problem resolved Problem improved Problem unimproved Assistance refused Not disclosed
Job Impairment after EAP Sessions: Performance improved Performance unimproved No longer employed Not applicable
If this patient's health plan requires pre-authorization from Matrix, please attach the appropriate case review form and return to:
Matrix 2 Easton Oval, Suite 450 Columbus, OH 43219 Fax: 6140475-9821
