Get Cap Referral Form - Hptc

Filling out the CAP Referral Form - Hptc online is a crucial step in the referral process for the Court Alternative Program. This guide will provide you with clear, step-by-step instructions to complete the form accurately and efficiently.

Follow the steps to successfully complete the CAP Referral Form - Hptc online.

1. Press the ‘Get Form’ button to access the referral form. This will allow you to obtain the document open in your preferred editor.
2. Begin with the section titled 'Client Information.' Fill in the client's full name, date of birth (DOB), primary language, gender, and marital status. Ensure that you provide accurate contact information, including home and cell phone numbers.
3. Complete the address field with the client's complete address, including city, state, and zip code. Also, provide an emergency contact's name and phone number, along with the client's social security number (SS#) and insurance details, including the policy number.
4. Move to the 'Court Information' section next. Fill in the name of the court, details on any criminal charges, and the pending sentence without CAP completion. Include the probation officer's contact information, along with that of the defense attorney.
5. In the 'General and Medical Information' section, provide the name, address, and phone number of the client's primary care provider (PCP) and psychiatrist. Indicate any medical issues and complete the inquiries about current medical conditions and pregnancy status.
6. Next, evaluate and document any past or current mental health issues, including diagnoses, self-injurious behaviors, suicidal or homicidal ideation, and any previous psychiatric hospital admissions. Make sure to note when and where any relevant behaviors occurred.
7. In the 'Medication/Dosage' field, provide accurate information on any medications the client is currently taking, including dosages.
8. Proceed to the 'Substance Abuse' section. Outline the client's primary drug of choice, age of first use, and date of last use. Fill out the frequency of use and list any instances of previous overdoses, assaults, or related behaviors.
9. Indicate whether the client has undergone any recovery services, detailing specifics such as detox, outpatient programs, and attendance at recovery meetings.
10. Before finalizing the form, ensure that all requested documentation is included: the completed referral form, the client’s current CORI, current probation stipulations, and contact information for a telephone interview.
11. After completing all sections, make sure to review the form for accuracy. Save any changes you made to the document, and then download, print, or share the completed form as required.

Start filling out the CAP Referral Form - Hptc online today to ensure a timely referral process.