Get Ab-1424 Bformb - Alameda County Behavioral Health - Acbhcs

Filling out the AB-1424 BFormb is an important step in communicating vital mental health history. This guide provides clear, step-by-step instructions to help you accurately complete the form online.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the form and open it in your document editor.
2. Enter the name of the consumer in the designated field. Ensure the spelling is correct as this will be used for identification purposes.
3. Fill in the consumer's date of birth and phone number. This information is crucial for emergency contact purposes.
4. Complete the address section accurately, including street address, city, state, and zip code.
5. Indicate the primary language and religion of the consumer in the relevant fields.
6. Specify if the consumer has Medi-Cal or Medicare by marking 'Yes' or 'No.' Also, note the name of the private medical insurer if applicable.
7. Ask the consumer to sign the authorization permitting Alameda County mental health providers to communicate with the person filling out the form about their care.
8. Indicate the preferred method of contact in emergencies, transfers, or discharges by marking 'Yes' or 'No.'
9. State whether the consumer has a Wellness Recovery Action Plan (WRAP) or Advance Directive. Attach a copy if available.
10. Provide a brief history of the consumer's mental illness, including age of onset, prior 5150’s, hospitalizations, and any relevant notes. Use additional pages if necessary.
11. Confirm if the consumer has a conservator and provide their name and phone number if applicable.
12. Indicate whether you know the consumer's diagnosis and provide necessary explanations.
13. Detail any known substance abuse problems and include explanations as needed.
14. List current medications, including psychiatric and medical, along with any that have been effective or ineffective.
15. Identify the treating psychiatrist and case manager with their contact information.
16. Describe significant medical conditions and any allergies the consumer may have.
17. Indicate the consumer's current living situation and assess its stability.
18. Provide your details as the person submitting the information, including name, relationship to the consumer, address, and phone number.
19. Sign and date the form, ensuring all provided information is accurate and truthful.
20. Once you have completed the form, save changes, and download or print the form as needed for submission.

Complete the AB-1424 BFormb online today to ensure timely communication of important mental health history.