Get Crr Mprs Shpcbh Referral Form - Lehigh - Northamptoncounty

Completing the CRR MPRS SHPCBH referral form is an essential step in securing appropriate care and support for individuals in need. This guide will provide clear instructions on how to fill out the form online, ensuring you have all the necessary information at your fingertips.

Follow the steps to complete the referral form accurately.

1. Click the ‘Get Form’ button to access the referral form and open it in your preferred online editor.
2. Begin by filling in the 'Date of Referral' field with the current date.
3. Select the appropriate referral type by checking the appropriate box for either 'Full Care Adult C.R.R. (24hr Residential)' or 'Full Care Young Adult C.R.R. (24hr Residential)'.
4. Specify the 'County of Referral' by selecting either Lehigh or Northampton.
5. Enter the 'Referral Source' information, including the name, agency, address, phone number, and email address.
6. Fill in the 'Current living arrangement' and 'Current phone number' fields.
7. Provide details for the individual being referred, including their name, county case number, current address, date of birth, social security number, and marital status.
8. List the diagnosed conditions in the 'Diagnosis' section, filling in the applicable DSM-IV Axis information.
9. Include information about the individual's monthly income and insurance details, ensuring to attach any relevant policy numbers.
10. Detail any outstanding medical conditions, legal charges, and history related to drug and alcohol use, along with any past agency or treatment facility involvement.
11. In the 'Reason for Referral' section, outline the specific needs of the individual and check if you have included the required documentation, such as psychiatric evaluations and signed releases of information.
12. Once all necessary sections are complete, review the form for accuracy and clarity.
13. Save your changes, and download, print, or share the completed form as required.

Start filling out the CRR MPRS SHPCBH referral form online now to ensure timely and accurate processing.