Get Portland Dbt Program Referral Information Form
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How to fill out the Portland DBT Program Referral Information Form online
The Portland DBT Program Referral Information Form is an essential document for providing necessary details to facilitate a client's referral. This guide will assist you through each section of the form, ensuring a comprehensive and accurate submission.
Follow the steps to complete the form with ease.
- Press the ‘Get Form’ button to access the Portland DBT Program Referral Information Form and open it in your preferred online editor.
- Begin by entering the details of the staff member receiving the call. This includes the date, name of the person referring the client, their relation to the client, and relevant contact information including address, phone, and email.
- Indicate the best time to call and whether a message can be left. Fill in the client's information, which includes their date of birth, age, full name, address, phone, email, and the best time to connect.
- If the client is a teen, provide the name of a parent or guardian. Next, indicate the referral source by selecting appropriate options such as hospital, school, agency, or others. Include how the client heard about the program.
- Detail any concerns the client may have, such as eating disorders or substance abuse, and provide explanations where instructed. Indicate the client's availability for appointments by specifying days and times.
- For payer information, enter the payment type and relevant insurance details, including the insurance ID and group number. Specify if pre-authorization is required and fill in the authorized sessions if applicable.
- Complete any additional information required for teen or eating disorder referrals, as well as a phone log for documenting communication attempts. Enter notes as necessary.
- Once all sections are complete, review the form for accuracy. You can then proceed to save your changes, download, print, or share the completed form.
Complete the Portland DBT Program Referral Information Form online today to ensure timely and accurate processing.
Some insurance plans may not cover Dialectical Behavior Therapy due to its specific framework and the extensive training required for providers. While this can be frustrating, utilizing the Portland DBT Program Referral Information Form can clarify your options and direct you toward possible resources. It’s essential to explore funding alternatives or out-of-pocket considerations to ensure you receive the care you need.
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