Get Older Adult Fsp Fillable Form

The Older Adult Fsp Fillable Form is designed to facilitate the referral and authorization process for older adults seeking mental health services. This guide will walk you through the steps to complete the form efficiently and accurately, ensuring that all necessary information is included.

Follow the steps to complete the Older Adult Fsp Fillable Form online.

1. Press the ‘Get Form’ button to download the form and access it in an online PDF editor.
2. Begin by entering the referral information at the top of the form. This includes the DMH identification number, date, social security number, and demographic details such as the last name, first name, date of birth, and race or ethnicity.
3. Fill in the contact address, phone number, preferred language, gender, and current living situation. Ensure that the contact information is accurate to facilitate communication.
4. Indicate the type of insurance the individual possesses by checking the relevant boxes, including options for Medi-Cal, Medicare, or private insurance.
5. In the referral source section, list the agency providing the referral, including their contact details. Specify if the individual is currently receiving mental health services, and include any other agency involvement.
6. Circle the appropriate reasons for the referral concerning serious mental illness from the provided checkboxes. Elaborate on any checked items in the space provided.
7. Complete the level of service section by checking one of the options that best describes the individual's current mental health service involvement.
8. Fill out diagnostic considerations by indicating the primary diagnosis and checking any items that apply to the individual, including any histories of aggression or psychiatric hospitalizations.
9. Refer to the area designated for disposition. This section is often completed by the service area impact unit, but necessary information should still be noted.
10. Once all sections are filled out, review the completed form for accuracy. Users can then save changes, download, print, or share the form as needed.

Make sure to complete and submit the Older Adult Fsp Fillable Form online to ensure timely processing of the referral.