Get Confidential Referral Form - Bamethysthousebbcab

This guide provides clear and supportive instructions for completing the Confidential Referral Form for Amethyst House online. By following these steps, users will be able to successfully fill out the form to facilitate recovery services.

Follow the steps to complete the form effectively.

1. Use the ‘Get Form’ button to obtain the Confidential Referral Form and open it in your document editor.
2. Begin by entering the 'Client Name' in the designated field. This is essential for identifying the individual seeking assistance.
3. In the 'Referring Agent' section, provide the agent's name and the agency they represent, along with their phone number, fax number, and email address.
4. Complete Part 1 – General Information by providing other names, gender, cultural/ethnic identity, status, address, contact numbers, and details regarding next of kin and emergency contact information.
5. Indicate whether the client has dependent children and provide details about living situations and employment status.
6. In the section concerning the 'Current Situation/Areas of Concern', include any relevant crisis information and indicators that suggest the client is ready for recovery programming.
7. Document any safety concerns, legal issues, or additional relevant information in the provided sections.
8. Proceed to Part 2 – Medical Information and enter current medications, medical diagnoses, and details about allergies and special needs.
9. Continue with Part 3 – Mental Health, detailing the client's mental health history, symptoms, and any self-harming behaviors.
10. In Part 4 – Substance Use/Misuse History, provide information about the client's substance use, including types, methods, frequencies, and other addictions.
11. At the end of the form, ensure the client signs the authorization, confirming the accuracy of information provided and permitting the release of necessary details for their admission.
12. Finally, save any changes made to the form, and export it as a PDF or in your preferred format to download, print, or share as needed.

Complete the Confidential Referral Form online today to facilitate recovery services at Amethyst House.