Get Lct Referral Form

Filling out the Lct Referral Form online can streamline the process of seeking assistance for a child in need of services. This guide provides clear, step-by-step instructions to help you accurately complete each section of the form.

Follow the steps to complete the Lct Referral Form online

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. In the first section, clearly print the name of the child, including the last, first, and middle names. Fill in the address with complete street, town, state, and zip code information.
3. Provide the child's gender, race, ethnicity, religion, and birth date accurately to ensure correct identification.
4. Input the information for the mother, father, and any guardians, including names and phone numbers. Ensure you accurately capture their addresses.
5. In the section that addresses the purpose of seeking services, describe your reasons comprehensively. Use clear and specific language to detail the circumstances.
6. Record when the problem began, providing as precise a date as possible to give context to the situation.
7. Indicate any involvement with specific services, such as the Division of Rehabilitation Services or the Department of Social Services, by marking 'yes' or 'no' as appropriate.
8. In the school section, enter the name of the child's school and their current grade. Mention if the child has received special education services and, if applicable, detail what those services were.
9. List the child's current treating mental health or substance abuse provider(s) along with their contact numbers.
10. Detail the child's current medical and mental health diagnoses, as well as any prescribed medications. If applicable, clarify compliance with medication.
11. Address any previous experiences with counseling, residential treatments, or psychiatric hospitalizations by providing detailed information where needed.
12. Include any history of suicide attempts, drug or alcohol abuse, and the child's insurance details in the given fields.
13. Document the names, ages, and relationships of individuals in the child's current household.
14. Check any entitlements currently received by the child and provide additional names and addresses of individuals you would like to invite to the Local Care Team meeting.
15. Finally, ensure that the form is completed by entering the name and telephone number of the person completing the referral, and obtain the required signature from the LCT representative.
16. Once the form is completed, you can save changes, download the document, print it, or share it as necessary.

Start the process of completing your documents online today!