Get Cbhi Referral Form Pdf Format - Bay State Community Services - Baystatecs

Filling out the CBHI Referral Form is an essential step in accessing services through Bay State Community Services. This guide will walk you through each section of the form, ensuring that you complete it accurately and efficiently.

Follow the steps to complete the CBHI Referral Form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the referral date and admission date in the designated fields.
3. Fill in the youth's name, selecting the correct gender, and provide the date of birth by entering the appropriate information.
4. Input the social security number, street address, city, state, and zip code in the respective fields.
5. Provide a primary phone number, indicate if it is okay to leave a message, and fill in the work phone number with the same acknowledgment.
6. Select the youth's ethnicity and race from the options provided on the form.
7. Enter the names of the parent or legal guardian and their relationship to the youth, along with their phone number and message preferences.
8. Answer whether the youth has been served by Bay State Community Services in the past and provide the details of the referrer.
9. If applicable, record any special communication needs or safety concerns regarding the youth.
10. Indicate and complete the insurance information section thoroughly, providing necessary details about the primary and secondary insurance.
11. Document any involvement with state agencies, listing the contact information and roles of the individuals involved.
12. In the second section, outline the identified strengths, concerning behaviors, and specific needs of the youth as well as scheduling constraints.
13. Complete the TM assessed needs checklist, specifying goals or skills required.
14. Finally, ensure you include any required additional documents mentioned in the guidelines before submitting the form.
15. Once you have completed the form, you can save changes, download, print, or share the document as needed.

Start completing the CBHI Referral Form online today to ensure timely access to necessary services.