Get Salina West Prtf

The Salina West Prtf is an essential document for the referral process to the Salina West facility. This guide aims to provide clear and supportive instructions for users on how to accurately complete each section of the form online.

Follow the steps to fill out the Salina West Prtf online.

1. Press the ‘Get Form’ button to access the Salina West Prtf and open it in your preferred editor for online completion.
2. Begin by filling out the 'Date of Referral' section to indicate when the referral is being made.
3. Provide the youth's details, including their name, home address (including city, state, and zip), church preference, ethnic origin, and primary language.
4. In the section for United States citizenship, check the appropriate box to indicate whether the youth is a citizen.
5. Complete the information for Parent 1, including their name, address, employer, home phone number, and citizenship status.
6. Repeat the same procedure for Parent 2, ensuring that all information is accurate and complete.
7. If applicable, enter details for another guardian, including their name, address, and contact information.
8. Fill in essential information about the youth, such as date of birth, place of birth, last school attended, gender, social security number, current grade, weight, and height.
9. Identify who should be contacted regarding questions and treatment decisions by selecting the appropriate option.
10. Complete the insurance information section, including Medicaid and insurance details, and attach a picture of the insurance card as instructed.
11. Indicate the reason for referral, particularly if it concerns harm to self or others.
12. Document any client behaviors alongside the relevant dates and descriptions, selecting from the provided checkboxes.
13. List the placement history, detailing the most recent placements first, and include any mental health needs or history.
14. Review all entries for accuracy and completeness, ensuring that any necessary information or consents are documented.
15. Finally, save your changes, and download, print, or share the completed Salina West Prtf as needed.

Complete your Salina West Prtf online today to ensure a smooth referral process.