Get Ct Bhp Registration Template

The Ct Bhp Registration Template is a crucial document used for registering individuals seeking behavioral health services. This guide provides a clear, step-by-step approach to help you complete the form accurately and effectively while filing online.

Follow the steps to complete the Ct Bhp Registration Template.

1. Click ‘Get Form’ button to obtain the Ct Bhp Registration Template and open it in the designated editor.
2. Begin by entering the provider EDS/CMAP ID#, which is a required 9-digit Medicaid identification number.
3. Fill in the facility or provider name along with the contact number and extension for easy reference.
4. Provide the facility or provider service location to specify where the services are being provided.
5. Indicate the name of the clinician who filled out this form, along with their credentials or title to identify the responsible party.
6. Enter the member's name, Medicaid or consumer ID number, date of birth, and social security number as required fields.
7. Select the appropriate level of care by checking the relevant box that describes the type of service the member requires.
8. Answer the questions regarding the requested start date, prior registrations, and referral sources by choosing the most applicable options.
9. For any medical or behavioral diagnoses, input the diagnostic codes and descriptions, ensuring all required information is completed.
10. Provide social elements impacting the diagnoses by checking all applicable options, as this information is vital for treatment planning.
11. Complete the current risk and impairment assessments by selecting the correct ratings for each item based on the member's status.
12. Indicate if there are co-occurring mental health and substance abuse conditions, and whether psychiatric medication evaluation is indicated.
13. Make sure to check all required fields regarding the treatment plan, including the involvement of family members and consent to contact other providers.
14. Finally, review all entered information for accuracy. Save changes, and download, print, or share the completed form as necessary.

Complete your Ct Bhp Registration Template online today to ensure a smooth application process.