Get Dmh Area And Contact For Continuing Care Referral

This guide provides step-by-step instructions for completing the Dmh Area And Contact For Continuing Care Referral online. It is designed to help users navigate the form efficiently and accurately.

Follow the steps to complete the referral form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Fill out the hospital information section. This includes the referring hospital, referring physician's details, attending physician's information if applicable, and the hospital social worker's contact information.
3. In the identification section, enter the patient's name, date, address, preferred birth date, sex, race, and language. Indicate if the patient speaks English and if authorization for DMH continuing care services has been secured.
4. Provide the patient's health insurance information, including details such as the type of insurance, card numbers, and the name of the policyholder.
5. Complete the diagnosis section by filling in all relevant diagnostic details, including Axis I to Axis V and the date of inpatient admission.
6. Specify the patient's legal status, selecting from options provided and indicating any expiring dates or other legal issues as necessary.
7. Write a brief summary of the hospital course and current clinical status/mental state of the patient.
8. Document the history of risk behaviors, both current and past, by marking applicable items and providing further details if necessary.
9. List current psychiatric medications alongside their adherence status and any reported side effects.
10. Provide information on medical history, including any relevant medical problems, surgeries, and current medications.
11. Outline current involvement with community support systems and describe prior discharge attempts, including reasons for lack of success.
12. Complete the contact list, ensuring to include the names and contact details of applicable contacts like healthcare proxies, emergency contacts, and primary care physicians.
13. Have the treating physician review the clinical criteria, sign, and date the statement to affirm the patient's need for transfer.
14. Before submitting, ensure all required forms and contact records are attached and the necessary signatures are obtained.
15. Once the form is completed, save changes, download, print, or share the document as required.

Complete your Dmh Area And Contact For Continuing Care Referral online today to ensure timely processing.