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$13.80$13.80
Ships from: Amazon Sold by: MYSKY HOME INC
$11.96$11.96
Ships from: Amazon Sold by: MYSKY HOME INC
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MYSKY HOME Navy Blue Curtains 84 Inch Long Blackout Curtains for Living Room Bedroom Blue Curtains Grommet Window Curtains Privacy Protect Room Darkening Single Panel Curtains, 52 x 84 Inch
Sustainability features
OEKO-TEX STANDARD 100
STANDARD 100 by OEKO-TEX requires every component of a textiles product—including all thread, buttons, and trims—to be tested against a list of more than 1,000 harmful regulated and unregulated chemicals which may be harmful to human health. The assessment process is globally standardized, independently conducted, and updated at least once a year based on new scientific information or regulatory requirements. Certification focus: #ProductSafety and #ChemicalsUsed.
Certification Number
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Return this item for free
We offer easy, convenient returns with at least one free return option: no shipping charges. All returns must comply with our returns policy.
Learn more about free returns.- Go to your orders and start the return
- Select your preferred free shipping option
- Drop off and leave!
Purchase options and add-ons
Brand | MYSKY HOME |
Color | Navy |
Material | Fabric |
Product Dimensions | 84"L x 52"W |
Opacity | Blackout |
About this item
- 100% Polyester
- Amazing Triple Weave Fabric: These soft and durable window curtains adopt special triple weave technology. The black light-blocking yarns are woven between the two colored yarns. Our light blocking curtain with no liner, both side are the same color.
- Package Detail: Each package include 1 curtain panel. Each panel measures 52 inch wide by 84 inch long and has 8 premium anti-rust grommets on the top. For better fullness, the combined width of panels should be 1.5 to 2 times the width of the curtain rod
- Privacy & Light Blocking: Curtains provide a safe and private home environment for you and your family. These room darkening curtains also make your bedroom not to be flooded with light in early morning, bring you a good sleep
- Energy Saving: These curtains help to resist cold drafts in winter and block the cool conditioning air from escaping in summer, save spend on heating and cooling your home. These curtains are a perfect addition to bedroom, living room, kids room, nursery
- Easy Care: These blocks out curtains are machine washable, delicate cycle with mild detergent, tumble dry. Do not bleach. Wrinkles caused by packaging disappear after hanging for weeks or wash with cold water
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- Sustainability features for this product
Sustainability features
This product has sustainability features recognized by trusted certifications.Safer chemicalsMade with chemicals safer for human health and the environment.As certified byOEKO-TEX STANDARD 100
STANDARD 100 by OEKO-TEX requires every component of a textiles product—including all thread, buttons, and trims—to be tested against a list of more than 1,000 harmful regulated and unregulated chemicals which may be harmful to human health. The assessment process is globally standardized, independently conducted, and updated at least once a year based on new scientific information or regulatory requirements. Certification focus: #ProductSafety and #ChemicalsUsed.Certification NumberSHHO 079459 - Sustainability features for this product
Sustainability features
This product has sustainability features recognized by trusted certifications.Safer chemicalsMade with chemicals safer for human health and the environment.As certified byOEKO-TEX STANDARD 100
STANDARD 100 by OEKO-TEX requires every component of a textiles product—including all thread, buttons, and trims—to be tested against a list of more than 1,000 harmful regulated and unregulated chemicals which may be harmful to human health. The assessment process is globally standardized, independently conducted, and updated at least once a year based on new scientific information or regulatory requirements. Certification focus: #ProductSafety and #ChemicalsUsed.Certification NumberSHHO 090941 - Sustainability features for this product
Sustainability features
This product has sustainability features recognized by trusted certifications.Safer chemicalsMade with chemicals safer for human health and the environment.As certified byOEKO-TEX STANDARD 100
STANDARD 100 by OEKO-TEX requires every component of a textiles product—including all thread, buttons, and trims—to be tested against a list of more than 1,000 harmful regulated and unregulated chemicals which may be harmful to human health. The assessment process is globally standardized, independently conducted, and updated at least once a year based on new scientific information or regulatory requirements. Certification focus: #ProductSafety and #ChemicalsUsed.Certification NumberBJ025 155029 - Sustainability features for this product
Sustainability features
This product has sustainability features recognized by trusted certifications.Safer chemicalsMade with chemicals safer for human health and the environment.As certified byOEKO-TEX STANDARD 100
STANDARD 100 by OEKO-TEX requires every component of a textiles product—including all thread, buttons, and trims—to be tested against a list of more than 1,000 harmful regulated and unregulated chemicals which may be harmful to human health. The assessment process is globally standardized, independently conducted, and updated at least once a year based on new scientific information or regulatory requirements. Certification focus: #ProductSafety and #ChemicalsUsed.Certification Number21.HCN.90811 - Sustainability features for this product
Sustainability features
This product has sustainability features recognized by trusted certifications.Safer chemicalsMade with chemicals safer for human health and the environment.As certified byOEKO-TEX STANDARD 100
STANDARD 100 by OEKO-TEX requires every component of a textiles product—including all thread, buttons, and trims—to be tested against a list of more than 1,000 harmful regulated and unregulated chemicals which may be harmful to human health. The assessment process is globally standardized, independently conducted, and updated at least once a year based on new scientific information or regulatory requirements. Certification focus: #ProductSafety and #ChemicalsUsed.Certification NumberBJ025 155029 - Sustainability features for this product
Sustainability features
This product has sustainability features recognized by trusted certifications.Safer chemicalsMade with chemicals safer for human health and the environment.As certified byOEKO-TEX STANDARD 100
STANDARD 100 by OEKO-TEX requires every component of a textiles product—including all thread, buttons, and trims—to be tested against a list of more than 1,000 harmful regulated and unregulated chemicals which may be harmful to human health. The assessment process is globally standardized, independently conducted, and updated at least once a year based on new scientific information or regulatory requirements. Certification focus: #ProductSafety and #ChemicalsUsed.Certification Number21.HCN.90811
From the brand
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BLACKOUT CURTAINS AND SHEER
-
New Release in MYSKY HOME
-
COUCH COVERS
-
FLORAL CURTAINS
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POM POM SHEER CURTAINS
-
Printed Curtains
-
SHEER CURTAINS
-
TABLECLOTH
-
COTTON TABLECLOTH
Sustainability features
This product has sustainability features recognized by trusted certifications.
Made with chemicals safer for human health and the environment.
Product Description
Orange Curtain 1 Panel | Pink Pom Pom Double Layer Curtains | pinch pleated 100% blackout curtains | Pinch Pleated Linen Sheer Curtains 2 Panels | Floral Blackout Curtains 2 Panels | Red Floral Sheer Curtains | |
Customer Reviews |
4.5 out of 5 stars
10,456
|
4.8 out of 5 stars
306
|
4.8 out of 5 stars
33
|
4.6 out of 5 stars
35
|
4.7 out of 5 stars
1,859
|
4.8 out of 5 stars
179
|
Price | $15.99$15.99 | $52.99$52.99 | $49.95$49.95 | $35.99$35.99 | $34.99$34.99 | — |
Material | Triple Weaved Fabric | Sheer and Triple Weaved Fabric | Cotton Blend Texture Fabric with 100% Blackout Fabric | Linen Blend Sheer | Triple Weaved Fabric | Sheer |
Pattern | Solid | White pom pom design sheer | Solid | Solid | Flower | Flower |
Package | 1 Panel | 2 Panels | 2 Panels | 2 Panels | 2 Panels | 2 Panels |
Privacy | √√√√ | √√√√ | √√√√√√ | √√ | √√√√ | √√√ |
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Nursery must have or if you need darkness to sleep
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MYSKY HOME Navy Blue Blackout Curtains
MYSKY HOME INC
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0:41
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What I Love About These Mysky Home Blackout Curtains
Benjamin and Ashley
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0:54
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Amazing curtain for a great price! Blackout!
Maegan Pitts
Product information
Brand | MYSKY HOME |
---|---|
Color | Navy |
Material | Fabric |
Product Dimensions | 84"L x 52"W |
Opacity | Blackout |
Special Feature | Room Darkening, Window Treatments |
Room Type | Kitchen, Living Room, Bedroom, Dining Room |
Style | Modern |
Pattern | Solid |
Theme | Solid Curtains |
Curtain Form | Drapes |
Top Style | Grommet |
Size | 52"W x 84"L (Pack of 1) |
Included Components | Tie Back, Heading Tape, Rod, Valance, Liner, Grommet, Eyelet, Hook |
Recommended Uses For Product | Indoor |
Specific Uses For Product | Room Darkening, Privacy |
Weave Type | Triple Weave |
Seasons | All Season |
Hanging Method | Grommet |
Item Weight | 0.68 Kilograms |
Closure Type | Grommet |
Number of Items | 1 |
Product Care Instructions | Machine Wash |
Lining Description | Unlined |
Package Weight | 0.71 Kilograms |
Water Resistance Level | Not Water Resistant |
Fabric Type | 100% Polyester |
Unit Count | 1.0 Count |
Compatible with Rod Size | 1.6 Inches |
Model Name | 1 |
Item Weight | 1.5 pounds |
ASIN | B016Y1Q3TU |
Item model number | SYNCHKG075885 |
Customer Reviews |
4.5 out of 5 stars |
Best Sellers Rank | #8,527 in Home & Kitchen (See Top 100 in Home & Kitchen) #104 in Window Curtain Panels |
Is Discontinued By Manufacturer | No |
Volume | 1 Cubic Inches |
Antibacterial treatment | Platform |
Perfume | Unscented |
Assembly required | No |
Number of pieces | 243 |
Batteries required | No |
Warranty & Support
Feedback
Important information
Follow the care instructions to maintain the curtains' quality and appearance.
Compare with similar items
This Item MYSKY HOME Navy Blue Curtains 84 Inch Long Blackout Curtains for Living Room Bedroom Blue Curtains Grommet Window Curtains Privacy Protect Room Darkening Single Panel Curtains, 52 x 84 Inch | Recommendations | |||||
Try again! Added to Cart | Try again! Added to Cart | Try again! Added to Cart | Try again! Added to Cart | Try again! Added to Cart | Try again! Added to Cart | |
Price | $13.80$13.80 | $20.99$20.99 | $28.99$28.99 | $23.99$23.99 | $19.98$19.98 | $20.99$20.99 |
Delivery | Get it as soon as Monday, Jan 20 | Get it as soon as Monday, Jan 20 | Get it as soon as Monday, Jan 20 | Get it as soon as Monday, Jan 20 | Get it as soon as Monday, Jan 20 | Get it as soon as Tuesday, Jan 21 |
Customer Ratings | ||||||
Sold By | MYSKY HOME INC | Amazon.com | COSVIYA | Diraysid INC | Amazon.com | DUALIFE |
size | 52"W x 84"L (Pack of 1) | 52"W x 84"L (Pack of 2) | 42"W x 84"L (Pack of 2) | 52"W x 84"L (Pack of 2) | 52"W x 84"L (Pack of 2) | 52"W x 84"L (Pack of 2) |
material | Fabric | Fabric | Polyester | Polyester | Polyester | Polyester |
special feature | Window Treatments, Room Darkening | Thermal Insulated, Uv Protection, Noise Reduction, Washable | Window Treatments, Blackout, Thermal Insulated, Uv Protection, Noise Reduction | Window Treatments, Blackout, Window Treatments | Blackout, Room Darkening, Thermal Insulated, Soundproof | Window Treatments, Noise Reduction, Thermal Insulated, UV Protection, Blackout |
top style | Grommet | Grommet | Grommet | Rod Pocket | Grommet | Grommet |
Customer reviews
Customer Reviews, including Product Star Ratings help customers to learn more about the product and decide whether it is the right product for them.
To calculate the overall star rating and percentage breakdown by star, we don’t use a simple average. Instead, our system considers things like how recent a review is and if the reviewer bought the item on Amazon. It also analyzed reviews to verify trustworthiness.
Learn more how customers reviews work on AmazonCustomers say
Customers appreciate the curtains' color, light blocking ability, and quality. They find the curtains look elegant and block out all light effectively. Many consider them a good product for the price, with strong stitching and 100% polyester material that looks expensive. The soft fabric is also appreciated, though opinions differ on the size.
AI-generated from the text of customer reviews
Customers like the color of the curtains. They say the curtains are beautiful and partially block light. The yellow ones are great, look elegant for the price, and are a perfect framing for their windows in the living room.
"...Otherwise I love the color and the material. I hope the rubber band idea works but it's still very beautiful!..." Read more
"This curtain worked great , blocks out the light , easy to hang , looks nice , great color , easy to wash and still looks brand new" Read more
"I love that they are blackout with the lining. Beautiful color." Read more
"Nice curtain love the orange but it was one curtain." Read more
Customers appreciate the curtains' ability to block out light. They say the curtains keep the room dark and cool at night. However, some customers mention that you can see pinholes of light through the curtains.
"...Also in my room it gets really dark which is what I want at night and early in the morning...." Read more
"This curtain worked great , blocks out the light , easy to hang , looks nice , great color , easy to wash and still looks brand new" Read more
"I love that they are blackout with the lining. Beautiful color." Read more
"These curtains are really good quality. They do a good job at keeping the light out." Read more
Customers appreciate the curtains' quality. They say the fabric is strong, the stitching is straight, and the 100% polyester material is of good quality.
"...The curtains are still great quality curtains and I'm glad I bought two instead of one because I can just open and close it whenever I want!..." Read more
"These curtains are really good quality. They do a good job at keeping the light out." Read more
"I like the quality of these curtians Great value for the money. The size is perfect. Easy to hang. I use them for my closet...." Read more
"...It's a shame too, because the CURTAIN itself is well-made...." Read more
Customers appreciate the curtains' value for money. They find the curtains decent quality for the price, with good material and color that looks expensive. The curtains block out light effectively and are worth the effort.
"I like the quality of these curtians Great value for the money. The size is perfect. Easy to hang. I use them for my closet...." Read more
"...I ordered these because they were half the price...." Read more
"...Otherwise, it is lightweight and does the job for the price." Read more
"My living room and it really a good purchase" Read more
Customers appreciate the thickness of the curtains. They find the material nice, thick, and not made of plastic like cheaper blackout curtains. The thickness also blocks light effectively.
"...Otherwise I love the color and the material. I hope the rubber band idea works but it's still very beautiful!..." Read more
"...I like that they are black out so you can not see thru them. I like the fabric and the weight of them. I do recommend them" Read more
"Loved the fabric!" Read more
"...I clearly needed two but overall it looked and felt like good material" Read more
Customers like the soft fabric of the curtains. They appreciate the thickness and texture, mentioning it looks plush and smooth. The material is nice and soft but thin, so you can see light through them.
"...They are soft, not stiff, which I like. They are wrinkled when they arrive so will either need to be steamed or put in the dryer for a few minutes...." Read more
"Nice curtain as far as look and feel of material but 42 inch wide curtain left an inch open on each side when hung in opening less than 40 inches...." Read more
"The cloth is very soft and just very very superb." Read more
"...I love the fact that they blackout the room, they’re rich in color, so soft and just added so much of a “home” kind of vibe to my living room...." Read more
Customers appreciate the curtains. They say the 1" thickness provides enough light to see through, and it works well for personal use. The curtains also block sunlight effectively and are reasonably priced. Some customers find them a convenient solution for angled windows.
"...It was such an easy fix! Putting the rubber bands would have defeated the whole purpose on why I bought it in the first place!..." Read more
"This curtain worked great , blocks out the light , easy to hang , looks nice , great color , easy to wash and still looks brand new" Read more
"It works exactly as I bought it to keep the AC on one side of the house from the hallway...." Read more
"Love the color! Works week as blackouts curtains!" Read more
Customers have mixed opinions about the size of the curtains. Some find them the correct length and fit well, with large grommets that make it easy to hang onto their curtain rod. Others mention the width was a bit shorter than expected, each panel was different length, and the edges bowed, exaggerating the unevenness. Overall, the size seems inconsistent for some customers.
"...The only thing is that the width was perfect but I wish the curtains was shorter lengthwise...." Read more
"...Great value for the money. The size is perfect. Easy to hang. I use them for my closet. I like that they are black out so you can not see thru them...." Read more
"...The first time the curtain wasn't the length it said it was supposed to be on the package, the second time there were holes...." Read more
"I love the color and the length of these curtains. It gives my room a warmth feel to it." Read more
Reviews with images
SURPRISE! You only get ONE PANEL!!! Misleading product link!
Top reviews from the United States
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- Reviewed in the United States on February 24, 2024Color: Mustard YellowSize: 42"W x 84"L (Pack of 1)Verified PurchaseUpdate: The cats got used to it and all I had to do was cut the bottom part by a few inches and the cats go in and out like it's nothing and I get to have the Privacy that I wanted! It was such an easy fix! Putting the rubber bands would have defeated the whole purpose on why I bought it in the first place! The curtains are still great quality curtains and I'm glad I bought two instead of one because I can just open and close it whenever I want! Also in my room it gets really dark which is what I want at night and early in the morning. I also live with my dad and he gets up earlier than me so I don't want that bright light shining in my eyes and my cats can't stand when I close the door so this was just a better alternative! I also got a new fabric dresser instead of the pink one because that was just a temporary place for it. The mustard colored curtains are so beautiful in my room and it compliments my whole room!
Orginal: I really like this a lot and it offers privacy while still allowing my cats to get in. The only thing is that the width was perfect but I wish the curtains was shorter lengthwise. One of my cats started playing with it and so I came up with the idea to tie both ends with a rubber band. Otherwise I love the color and the material. I hope the rubber band idea works but it's still very beautiful! I also had to cut the curtains a little bit shorter so my cats wouldn't play with it and so far it has worked! So far they have been able to get in and out without getting into mischief! I also loved how it was 50% off and I got a great deal on them! I would definitely buy from them again!
5.0 out of 5 stars I love it and it offers privacy while my cats can still get in my room.Update: The cats got used to it and all I had to do was cut the bottom part by a few inches and the cats go in and out like it's nothing and I get to have the Privacy that I wanted! It was such an easy fix! Putting the rubber bands would have defeated the whole purpose on why I bought it in the first place! The curtains are still great quality curtains and I'm glad I bought two instead of one because I can just open and close it whenever I want! Also in my room it gets really dark which is what I want at night and early in the morning. I also live with my dad and he gets up earlier than me so I don't want that bright light shining in my eyes and my cats can't stand when I close the door so this was just a better alternative! I also got a new fabric dresser instead of the pink one because that was just a temporary place for it. The mustard colored curtains are so beautiful in my room and it compliments my whole room!
Reviewed in the United States on February 24, 2024
Orginal: I really like this a lot and it offers privacy while still allowing my cats to get in. The only thing is that the width was perfect but I wish the curtains was shorter lengthwise. One of my cats started playing with it and so I came up with the idea to tie both ends with a rubber band. Otherwise I love the color and the material. I hope the rubber band idea works but it's still very beautiful! I also had to cut the curtains a little bit shorter so my cats wouldn't play with it and so far it has worked! So far they have been able to get in and out without getting into mischief! I also loved how it was 50% off and I got a great deal on them! I would definitely buy from them again!
Images in this review - Reviewed in the United States on December 26, 2024Color: TealSize: 42"W x 72"L (Pack of 1)Verified PurchaseThis curtain worked great , blocks out the light , easy to hang , looks nice , great color , easy to wash and still looks brand new
- Reviewed in the United States on January 10, 2025Color: LilacSize: 52"W x 63"L (Pack of 1)Verified PurchaseI love that they are blackout with the lining. Beautiful color.
- Reviewed in the United States on October 26, 2024Color: OrangeSize: 52"W x 108"L (Pack of 1)Verified PurchaseNice curtain love the orange but it was one curtain.
- Reviewed in the United States on January 6, 2025Color: NavySize: 52"W x 84"L (Pack of 1)Verified PurchaseThese curtains are really good quality. They do a good job at keeping the light out.
- Reviewed in the United States on September 6, 2024Color: BeigeSize: 52"W x 63"L (Pack of 1)Verified PurchaseI like the quality of these curtians
Great value for the money. The size is perfect. Easy to hang. I use them for my closet. I like that they are black out so you can not see thru them. I like the fabric and the weight of them. I do recommend them
- Reviewed in the United States on October 12, 2024Color: Royal BlueSize: 52"W x 84"L (Pack of 1)Verified PurchaseBeautiful and partially blocks light, but I only needed it for looks and frame my large window.
Bought 2 panels, since it only come with one.
- Reviewed in the United States on August 10, 2016Color: TealSize: 52"W x 63"L (Pack of 1)Verified PurchaseCRC URGENT ENROLLMENT CHEAT SHEET
Services:
AHCCCS
• Case Management
o Therapy, Psych Evaluation, Support Groups, Direct Support Specialist, etc.
Private Insurance/Third Party Insurance (Non-AHCCCS)
• Sliding Scale/Co-Pay Fee for Case Management Services
• Medical Services, Psych Evaluation, Support Groups
Activation for an Urgent Enrollment
CRC
• CRC Staff should check the Cenpatico Portal Website to ensure member does not already have an ‘Intake Agency’ and determine member’s insurance status
o If the Cenpatico Portal Website reports an ‘Intake Agency,’ we cannot enroll that member regardless if family reports closing out with that agency
• If member does not have an intake agency, therapist, a psychiatrist, etc. and wants to enroll with CHA, CRC Staff needs to call Nursewise to activate the urgent enrollment
• You will need to sign the ‘Urgent Enrollment Note’ in the CRC computer system to report that you spoke with the family
• Report to CRC Staff if member enrolled with CHA or not
Nursewise
• At the end the urgent enrollment, contact Nursewise’s Hospital Line at 1 (844) 259-4971 to give the Nursewise staff your urgent enrollment disposition
o “Hello, my name is [Your Name] from CHA and I am calling to give you my urgent enrollment disposition.”
• Nursewise will need the Member’s Name, Date of Birth, the time you started the urgent enrollment (or time you started talking to the family), and the time you ended the urgent enrollment (or the time you stopped talking to the family.
AHCCCS
CIA Admission Bundle (Includes Financial)
• ‘Admission’ Tab
o Preadmit/Admission Date: [Date of Assessment]
o Preadmit/Admission Time: [Start Time]
o Program: ***Tucson – Admit***
o Type of Admission: First Admission
o Source of Admission: CPS 24 HR Urgent Response
o Case Manager: Sean Kewin
o CIS# (Facility Chart Number): [CIS #]
o Social Security Number: [SSN, if unknown, leave blank]
o Received Copy of Client Rights: Yes
o Advanced Directive: No
• ‘Demographics’ Tab
o Address – Street: [Member’s Address]
o Zipcode: [Member’s Zipcode]
o City: [Member’s City]
o State: [Member’s State]
o County: [Member’s County]
o Home Phone: [Legal Guardian’s Phone Number]
o Emergency or Work Phone: [Emergency Contact’s Phone, or Legal Guardian’s Number]
o Email Address: [Legal Guardian’s Email, if none, type “NONE”]
o Employment Status: ‘Student’ or ‘Unknown (ages 0 thru 17 only)’ if Member not in school
o Marital Status: [Status]
o Primary Language: [Language]
o Client Race: [Race]
o Ethnic Origin: [Hispanic/Latino or Non-Hispanic/Non-Latino]
o Country of Origin: [Country]
o Education: [Last Grade Completed]
• ‘Other Client Data’ Tab
o Veteran: N/A
• Referral Source
o Primary Referral Source Code: Crisis Response Center (65)
• Cenpatico Referral Information
o Effective Date: [Date of Admission]
o Referral Date: [Date of Admission]
o Referral Source: [DCS 24-Hour Urgent Response]
o Was an appointment offered to member?: Yes
o First Available Date Offered to Client: [Date of Admission]
o Did the member decline first offered appointment?: No
o Is first offered appointment more than 7 days from Referral Date?: No
o Is first appointment scheduled?: Yes
o Date of First Scheduled Appointment: [Date of Admission]
o Outcome of First Scheduled Appointment: Member Showed
o Financial Eligibility: [Insurance Type]
♣ AHCCCS – ‘T19’
♣ Private Insurance – ‘NT’
♣ KidsCare – ‘T21’
♣ No Insurance – ‘Not Eligible/Not in AHCCCS System’
• Cenpatico Demo
o Referral Date: [Date of Admission]
o Referral Source: CPS – 24 Hr Urg Resp
o Military Status: N/A
o Household Income: 0
o Household Size: 1
o Is the Participant a Medicare Beneficiary without AHCCCS?: No
o Has a Limited Subsidy Application been Filed?: No
o Reason LIS Application has not been filed?: Not Eligible
o Does Participant have Medicare Part D?: No
• AHCCCS Eligibility Screening:
o Date of Screening: [Date of Admission]
o Type of Screening: [Initial]
o A.1 Is the member already AHCCCS eligible?: Yes
o A.2 Does the member have an AHCCCS application pending?: No
o Click ‘Final,’ ‘Submit,’ ‘Accept’
• Financial Eligibility
o Guarantor Selection Tab
♣ Guarantor #: (841) TXIX – Child
♣ Customize Guarantor Plan: No
♣ Coverage Effective Date: [Date of Admission]
♣ Eligibility Verified: Yes
♣ Subscribers Employment Status: Student or Unknown
♣ Subscriber Policy #: [CIS #]
♣ Subscriber Medicaid/AHCCCS ID #: [AHCCCS ID #]
♣ Maintenance Reason Code: Initial Enrollment
♣ Subscriber Assignment of Benefits: Yes
♣ Subscriber Release of Information: Yes
♣ Coordination of Benefits: Yes
o Financial Eligibility Tab
♣ Guarantor #1: (841) TXIX – Child
• Parent Guardian
o Name: [Legal Guardian]
o Parent/Guardian Relationship: [Relationship]
o Parent/Guardian Home Phone: [Phone Number]
• Emergency Contact
o Emergency Contact Name: [Emergency Contact, if none, Legal Guardian]
o Emergency Contact Relationship: [Relationship]
o Emergency Contact Phone: [Number]
Interim Service Plan
• Plan Date: [Admission Date]
• Identify Specific People: [Legal Guardian, etc.]
• Identify Specific Documentation: [IEP, Probation Report, etc., if any; if none, type ‘None’]
• Identify Who the Member Should Contact: [CRC, Nursewise, CHA, etc.]
• Draft/Final: Draft
• Codes should include ‘Assessment,’ ‘Meet with BHP,’ and ‘Case Management’
• Next Steps:
o Assessment
♣ Description of Next Steps: “Assessment (H0031) 1-6 Times Per Year”
♣ Who will be Responsible: “Case Manager”
♣ Where Actions/Steps will Take Place: “CHA or in the Community”
♣ When Action/Step will Take Place: “First Assessment Completed on [Date of Assessment]”
o Meet with BHP
♣ Description of Next Steps: “Meet with BHP (H0004 or 90832) 1 Time”
♣ Who will be Responsible: “Assigned Case Manager will Arrange”
♣ Where Actions/Steps will Take Place: “CHA”
♣ When Action/Step will Take Place: “Within the Next 7 Days”
o Case Management
♣ Description of Next Steps: “Case Management (T1016) 1-20 Times Per Month”
♣ Who will be Responsible: “Assigned Case Manager”
♣ Where Actions/Steps will Take Place: “CHA or in the Community”
♣ When Action/Step will Take Place: “Within 30 Days”
CHA CASII
• Assessment Type: Initial
• CASII Date: [Date of Assessment]
• Draft of Final: Final
• Behavioral Health Staff Person: [Your Name]
• Are you a staff member? (Scroll to the bottom): Yes
• I-IV: Select the score and type out the corresponding justification of score in the box provided
• Click ‘Total Score’ to calculate the total
• Composite Score: [Total Score #]
• Level of Service Intensity: [Corresponding Level for Composite Score]
• Target Date for Next Update: [6 Months from Assessment Date]
• Rationale for Selected Level of Intensity: [Your Reasoning]
• CASII Level Recommendation: [Level of Service #]
• Actual CASII Level Being Provided: [Level of Service # – if # is less than ‘4,’ choose ‘4’]
• Reason or Comments if CASII Level Provided Differs…: [If Level of Service # is less than 4, then reasoning is because ‘Member was presented at the CRC.’ If level of Service # is 4 or higher, reasoning is ‘N/A.’]
• Which dimension rating(s) would be negatively impacted..: [Your justification/explanation]
Demographics 2015
• Effective Date: [Date of Admission]
• Draft/Final: Draft
• Completed By: [Your Name]
• Note to Demo Team: “EOC Start”
• AHCCCS ID: [AHCCCS ID #]
• Enter Age of Client: [Age]
• Reason for Submission: Episode of Care Start – Type 1
• Site Member is Assigned to: CHA Tucson
• Behavioral Health Category: ‘Child’ or ‘Child w/SED’
o Child w/SED – Refer to ICD-10 SED Codes
• Treatment Participation: Voluntary
• How often did the member participate in any self help…: [Amount]
• Is Member White?: [Yes or No]
• Is Member Asian?: [Yes or No]
• Is Member Black of African American?: [Yes or No]
• Is Member Hawaiian or Pacific Islander?: [Yes or No]
• Is Member American Indian or Alaska Native?: [Yes or No]
o If ‘Yes,’ select appropriate ‘Primary Tribal Affiliation’ and select ‘Yes’ or ‘No’ for ‘Does this person live on a reservation?’
• Is member Hispanic or Latino?: [Yes or No]
• Education Status: [Yes or No]
• School Special Education IEP: [No, Not Applicable, or Yes]
• Education Level Completed: [Last Grade Completed]
• Employment Status: [Student, or best fit option]
• Gender: [Female, Male, or Unknown]
o If ‘Female,’ select appropriate options for ‘Pregnant or Post Partum…’ and ‘Woman with Dependent Children…’
• ADJC – Juvenile Parole: [No, Not Applicable, Yes]
• AOC – Juvenile Probation: [No, Not Applicable, Yes]
• DES-RSA: No
• Primary Residence: [Residence Situation]
• Presenting Concern is Assaultive/DTO: [Yes or No]
• Presenting Concern is Self-Harm/DTS: [Yes or No]
• Has Diagnosis been Verified?: Yes
• AXIS IV – Primary: [Problem]
• AXIS IV – Secondary: [Problem]
• Physical Health Condition: [Condition]
• Is client an IV drug user: [Yes or No]
• Substance of Choice: [Substance]
o If a substance is chosen, make sure the diagnosis is consistent with this. In other words, the diagnosis should include the substance chosen.
o If substance is selected, select the corresponding responses for ‘Frequency of Use,’ Usual Route of Administration,’ and ‘Age of First Use.’
Diagnosis
• Type of Diagnosis: Admission
• Date of Diagnosis: [Date of Admission]
• Time of Diagnosis: [End Time of Admission]
• Click ‘New Row’
• Diagnosis Search: [Diagnosis]
• Status: Active
• Ranking: Primary
• Classification: [Axis I, II, or III for Diagnosis]
• Diagnosing Practitioner: [Your Name]
• If there additional Diagnoses, click ‘New Row’
o Diagnosis Search: [Diagnosis]
o Status: Active
o Ranking: Secondary/Tertiary
o Classification: [Axis I, II, or III]
o Diagnosing Practitioner: [Your Name]
o Repeat these steps as necessary
• Axis IV Primary Support Group: [Yes or No]
• Axis IV Social Environment: [Yes or No]
• Axis IV Educational: [Yes or No]
• Axis IV Occupational: [Yes or No]
• Axis IV Housing: [Yes or No]
• Axis IV Economic: [Yes or No]
• Axis IV Health Care Services: [Yes or No]
• Axis IV Legal System/Crime: [Yes or No]
• Axis IV Other Problems: [Yes or No]
• Diagnosis – Axis V Current GAF Rating: [GAF Score]
Core
• Billing
o Service Charge Code: Assessment (H0031)
o Duration: [Total Minutes Spent on Assessment]
o Practitioner: [Your Name]
o Program: Tucson Outpatient
o Location: Other
Scan “Assessment and Service Plan” and “Interim Service Plan Signature Page” to Rebecca Mclane (Becky)
• Minimize ‘ctremote.ciayuma.com’ screen
• Use printer/scanner to scan documents to CRC Scans Folder
• Go back into your ‘ctremote.ciayuma.com’ screen
• Open email, add attachment
• To find CRC Scans Folder
o ‘Computer’
o ‘C on CHATucson-PC’
o ‘CRC Scans’
Release of Information (Add to Folder in Cabinet)
• Folder in cabinet is labeled ‘Signed ROI’s’
• After a while, the accumulated ROI’s should be taken into the office to be scanned into member’s files
Daily CRC Update Email (To: jekent@cenpatico.com, kacason@cenpatico.com; CC: Sean Kewin, Matthew Lenertz, Rebecca Mclane (Becky), Rachel Bryant; BCC: Next person on shift)
• Email should contain the following information on each member enrolled that day/night:
o [secure]
Client Name: [Member’s First and Last Name]
DOB: [Date of birth; 00/00/0000]
Presenting problem and client disposition.
1. Is member newly enrolled with your agency? [Yes or No]
2. How did the member get to the CRC? (who transported the member, what happened right before member was taken to the CRC, etc.) [Brief summary of what brought member to the CRC, who was with member, who transported member]
3. Where did the member reside prior to being admitted to the CRC? (group home, home with family, foster home, kinship placement, behavioral health placement) [Member’s living situation]
4. What is the plan for member to discharge from the CRC including anticipated discharge date? [Discharge plan; date and time of discharge if discharged]
5. Is there an alternative CRC discharge plan? [Yes or No; and what was the plan]
6. Has the dedicated recovery coach or any member of the team visited the member at the CRC? [Yes or No]
7. Has there been a CFT since member has been at the CRC? If so, when? If not, is there one scheduled? If not scheduled, what are the barriers? [Yes or No; reasoning, barriers]
8. Are any community stakeholders involved such as JPO, DDD, DCS, etc.? [Yes or No; if yes, what stakeholders]
9. If incident leading to CRC admission originated at member’s school, what school does member attend? [Name of School, Current Grade Level]
Private Insurance/Third Party Insurance (Non-AHCCCS)
CIA Admission Bundle (Includes Financial)
• Admission
o Preadmit/Admission Date: [Date of Assessment]
o Preadmit/Admission Time: [Start Time]
o Program: ***Tucson – Admit***
o Type of Admission: First Admission
o Source of Admission: CPS 24 HR Urgent Response
o Case Manager: Sean Kewin
o CIS# (Facility Chart Number): [Avatar Chart Number]
o Social Security Number: [SSN, if unknown, leave blank]
o Received Copy of Client Rights: Yes
o Advanced Directive: No
• Demographics
o Address – Street: [Member’s Address]
o Zipcode: [Member’s Zipcode]
o City: [Member’s City]
o State: [Member’s State]
o County: [Member’s County]
o Home Phone: [Legal Guardian’s Phone Number]
o Emergency or Work Phone: [Emergency Contact’s Phone, or Legal Guardian’s Number]
o Email Address: [Legal Guardian’s Email, if none, type “NONE”]
o Employment Status: ‘Student’ or ‘Unknown (ages 0 thru 17 only)’ if Member not in school
o Marital Status: [Status]
o Primary Language: [Language]
o Client Race: [Race]
o Ethnic Origin: [Hispanic/Latino or Non-Hispanic/Non-Latino]
o Country of Origin: [Country]
o Education: [Last Grade Completed]
• Referral Source
o Primary Referral Source Code: Crisis Response Center (65)
• Cenpatico Referral Information
o Effective Date: [Date of Admission]
o Referral Date: [Date of Admission]
o Referral Source: [DCS 24-Hour Urgent Response]
o Was an appointment offered to member?: Yes
o First Available Date Offered to Client: [Date of Admission]
o Did the member decline first offered appointment?: No
o Is first offered appointment more than 7 days from Referral Date?: No
o Is first appointment scheduled?: Yes
o Date of First Scheduled Appointment: [Date of Admission]
o Outcome of First Scheduled Appointment: Member Showed
o Financial Eligibility: [Insurance Type]
♣ AHCCCS – ‘T19’
♣ Private Insurance – ‘NT’
♣ KidsCare – ‘T21’
♣ No Insurance – ‘Not Eligible/Not in AHCCCS System’
• Cenpatico Demo
o Referral Date: [Date of Admission]
o Referral Source: CPS – 24 Hr Urg Resp
o Military Status: N/A
o Household Income: 0
o Household Size: 1
o Is the Participant a Medicare Beneficiary without AHCCCS?: No
o Has a Limited Subsidy Application been Filed?: No
o Reason LIS Application has not been filed?: Not Eligible
o Does Participant have Medicare Part D?: No
• AHCCCS Eligibility Screening:
o Close out of this form (“X” icon on the left side of Avatar)
• Financial Eligibility
o ‘Guarantor Selection’ Tab
♣ First Guarantor
• Guarantor #: (848) Non-Title – XIX/XXI Child
• Customize Guarantor Plan: No
• Coverage Effective Date: [Date of Admission]
• Eligibility Verified: Yes
• Subscribers Employment Status: Student or Unknown
• Subscriber Policy #: [Avatar Chart #]
• Maintenance Reason Code: Initial Enrollment
• Subscriber Assignment of Benefits: Yes
• Subscriber Release of Information: Yes
• Coordination of Benefits: Yes
♣ Second Guarantor (Click ‘Add New Item’)
• Guarantor #: (222) Non-Title 834 Processing Only
• Customize Guarantor Plan: No
• Coverage Effective Date: [Date of Admission]
• Eligibility Verified: Yes
• Subscribers Employment Status: Student or Unknown
• Subscriber Policy #: 111528
• Maintenance Reason Code: Initial Enrollment
• Subscriber Assignment of Benefits: Yes
• Subscriber Release of Information: Yes
• Coordination of Benefits: Yes
o ‘Financial Eligibility’ Tab
♣ Guarantor #1: (848) Non-Title – XIX/XXI – Child
♣ Guarantor #2: (222) Non-Title 834 Processing Only
• Parent Guardian
o Name: [Legal Guardian]
o Parent/Guardian Relationship: [Relationship]
o Parent/Guardian Home Phone: [Phone Number]
• Emergency Contact
o Emergency Contact Name: [Emergency Contact, if none, Legal Guardian]
o Emergency Contact Relationship: [Relationship]
o Emergency Contact Phone: [Number]
Interim Service Plan
• Plan Date: [Admission Date]
• Identify Specific People: [Legal Guardian, etc.]
• Identify Specific Documentation: [IEP, Probation Report, etc., if any; if none, type ‘None’]
• Identify Who the Member Should Contact: [CRC, Nursewise, CHA, etc.]
• Draft/Final: Draft
• Includes should include ‘Assessment,’ and ‘Meet with BHP’
• Next Steps:
o Assessment
♣ Description of Next Steps: “Assessment (H0031) 1-6 Times Per Year”
♣ Who will be Responsible: “Case Manager”
♣ Where Actions/Steps will Take Place: “CHA or in the Community”
♣ When Action/Step will Take Place: “First Assessment Completed on [Date of Assessment]”
o Meet with BHP
♣ Description of Next Steps: “Meet with BHP (H0004 or 90832) 1 Time”
♣ Who will be Responsible: “Assigned Case Manager will Arrange”
♣ Where Actions/Steps will Take Place: “CHA”
♣ When Action/Step will Take Place: “Within the Next 7 Days”
CHA CASII (Optional)
• Assessment Type: Initial
• CASII Date: [Date of Assessment]
• Draft of Final: Final
• Behavioral Health Staff Person: [Your Name]
• Are you a staff member? (Scroll to the bottom): Yes
• I-IV: Select the score and type out the corresponding justification of score in the box provided
• Click ‘Total Score’ to calculate the total
• Composite Score: [Total Score #]
• Level of Service Intensity: [Corresponding Level for Composite Score]
• Target Date for Next Update: [6 Months from Assessment Date]
• Rationale for Selected Level of Intensity: [Your Reasoning]
• CASII Level Recommendation: [Level of Service #]
• Actual CASII Level Being Provided: [Level of Service # – if # is less than ‘4,’ choose ‘4’]
• Reason or Comments if CASII Level Provided Differs…: [If Level of Service # is less than 4, then reasoning is because ‘Member was presented at the CRC.’ If level of Service # is 4 or higher, reasoning is ‘N/A.’]
• Which dimension rating(s) would be negatively impacted..: [Your justification/explanation]
Diagnosis
• Type of Diagnosis: Admission
• Date of Diagnosis: [Date of Admission]
• Time of Diagnosis: [End Time of Admission]
• Click ‘New Row’
• Diagnosis Search: [Diagnosis]
• Status: Active
• Ranking: Primary
• Classification: [Axis I, II, or III for Diagnosis]
• Diagnosing Practitioner: [Your Name]
• If there additional Diagnoses, click ‘New Row’
o Diagnosis Search: [Diagnosis]
o Status: Active
o Ranking: Secondary/Tertiary
o Classification: [Axis I, II, or III]
o Diagnosing Practitioner: [Your Name]
o Repeat these steps as necessary
• Axis IV Primary Support Group: [Yes or No]
• Axis IV Social Environment: [Yes or No]
• Axis IV Educational: [Yes or No]
• Axis IV Occupational: [Yes or No]
• Axis IV Housing: [Yes or No]
• Axis IV Economic: [Yes or No]
• Axis IV Health Care Services: [Yes or No]
• Axis IV Legal System/Crime: [Yes or No]
• Axis IV Other Problems: [Yes or No]
• Diagnosis – Axis V Current GAF Rating: [GAF Score]
Comprehensive Psychosocial History
• Billing
o Service Charge Code: Assessment (H0031)
o Duration: [Total Minutes Spent on Assessment]
o Practitioner: [Your Name]
o Program: Tucson Outpatient
o Location: Other
Scan “Assessment and Service Plan” and “Interim Service Plan Signature Page” to Rebecca Mclane (Becky)
• Minimize ‘ctremote.ciayuma.com’ screen
• Use printer/scanner to scan documents to CRC Scans Folder
• Go back into your ‘ctremote.ciayuma.com’ screen
• Open email, add attachment
• To find CRC Scans Folder
o ‘Computer’
o ‘C on CHATucson-PC’
o ‘CRC Scans’
Release of Information (Add to Folder in Cabinet)
• Folder in cabinet is labeled ‘Signed ROI’s’
• After a while, the accumulated ROI’s should be taken into the office to be scanned into member’s files
Daily CRC Update Email (To: jekent@cenpatico.com, kacason@cenpatico.com; CC: Sean Kewin, Matthew Lenertz, Rebecca Mclane (Becky), Rachel Bryant; BCC: Jamie Le)
• Email should contain the following information on each member enrolled that day/night:
o [secure]
Client Name: [Member’s First and Last Name]
DOB: [Date of birth; 00/00/0000]
Presenting problem and client disposition.
1. Is member newly enrolled with your agency? [Yes or No]
2. How did the member get to the CRC? (who transported the member, what happened right before member was taken to the CRC, etc.) [Brief summary of what brought member to the CRC, who was with member, who transported member]
3. Where did the member reside prior to being admitted to the CRC? (group home, home with family, foster home, kinship placement, behavioral health placement) [Member’s living situation]
4. What is the plan for member to discharge from the CRC including anticipated discharge date? [Discharge plan; date and time of discharge if discharged]
5. Is there an alternative CRC discharge plan? [Yes or No; and what was the plan]
6. Has the dedicated recovery coach or any member of the team visited the member at the CRC? [Yes or No]
7. Has there been a CFT since member has been at the CRC? If so, when? If not, is there one scheduled? If not scheduled, what are the barriers? [Yes or No; reasoning, barriers]
8. Are any community stakeholders involved such as JPO, DDD, DCS, etc.? [Yes or No; if yes, what stakeholders]
9. If incident leading to CRC admission originated at member’s school, what school does member attend? [Name of School, Current Grade Level]
CHA Members at the CRC
CRC
• CRC Staff might ask for ‘Progress Notes’ and ‘Med List’ for member, if any
• Print out recent ‘Progress Notes’ and any medication lists in Avatar to hand to CRC Staff
Member Progress Note
• Select Episode: [Select the Correct Episode]
• Progress Note For: New Service
• Outreach Note: No
• Note Type: Progress Note
• Notes Field:
o “DAP” style summary of member’s presentation at CRC. You can either gather this yourself or staff with the CRC Crisis Worker. For example:
♣ O: [Objective of Note; i.e “To provide case management”]
D: [Data; Summary of what brought member to the CRC, what happened, who brought member, is member being admitted to the CRC or discharged home, etc.]
A: [Assessment; Member’s presentation/mental status, your clinical judgments, etc.]
P: [Plan; What is the plan, did member stay/go home, ‘CHA to follow up with member,’ etc.]
• Date of Service: [Date]
• Service Start Time: [Start Time]
• Service End Time: [End Time]
• Service Program: Case Management
• Location or Place of Service: Other
• Final, Submit
Email
• In Avatar, ‘Overview’ option of member’s chart should reveal who member’s Assigned Case Manager is if they are receiving case management services
o ‘Admit Practitioner’ Name of DRC
• Email the Assigned Case Manager (DRC) to let them know member was presented at the CRC and that you added a progress note
o Email to DRC; CC: Sean Kewin, Rachel Bryant
Transportation:
Member and Family
• CHA is contracted through Cenpatico to provide transportation home for any members (Youth) or member’s family members that have been seen at the CRC’s Youth Unit
• You can either
o Contact Nursewise to set up transportation through the Crisis Mobile Team
o Contact the Crisis Mobile Team yourself
o Or transport the youth/youth’s family member home yourself
erfectly
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