Get Centralized Psychiatric Consultation Service For Adults Referral Form

This guide provides a comprehensive overview of how to effectively complete the Centralized Psychiatric Consultation Service For Adults Referral Form online. By following the detailed steps outlined, users can ensure that all necessary information is accurately submitted for prompt processing.

Follow the steps to successfully complete the referral form online.

1. Click ‘Get Form’ button to obtain the referral form and open it in your preferred online editor.
2. Begin by entering the date in the specified format (DD/MM/YYYY). Ensure the entry is clear and legible.
3. Fill out the patient contact information section. Include the patient's full name, date of birth, address, health card number, and primary and secondary phone numbers.
4. Indicate the primary language spoken by the patient and whether an interpreter is required. Confirm if the patient is aware of the referral.
5. In the purpose of the assessment section, select all applicable reasons such as diagnostic clarification or treatment recommendations.
6. Detail the current problems or symptoms the patient is experiencing that necessitate assessment.
7. Select any relevant current mental health concerns from the provided list, ensuring to include any additional concerns identified.
8. If the patient has suicidal or self-harm thoughts, ensure this is documented for appropriate assessment and refer to emergency resources if necessary.
9. Document the patient's substance use history, including types of substances used and the date of last use.
10. Complete the treatment history section by listing current and previous medications and any psychotherapeutic strategies employed.
11. Provide information regarding any relevant medical or developmental history, including cognitive impairments and family history of medical and mental health issues.
12. Describe the living situation and any associated stressors. Indicate whether the situation is stable or unstable and detail the type of living arrangement.
13. Outline the financial situation of the patient, noting any stressors that may impact their well-being.
14. Complete the referring physician section by providing the physician's name, phone number, clinic name, and fax number.
15. Finally, ensure to sign the form, include the date of completion, and print your name as the referring physician.

Complete your referral form online today to ensure timely access to psychiatric consultation services.