Get Crisis/irts Assessment & Referral Form

The Crisis/IRTS Assessment & Referral Form is a critical document used to assess and refer individuals in need of support during a crisis. This guide will provide comprehensive, step-by-step instructions for completing the form online, ensuring clarity and ease of use for all users.

Follow the steps to complete the form with confidence.

1. Click the ‘Get Form’ button to access the Crisis/IRTS Assessment & Referral Form and open it in your chosen online editor.
2. Begin by filling in the required personal information, including the client’s name, date of birth, and medical record number. This information is essential for proper identification and coordination of care.
3. Provide the referral source's contact information, including their phone number, and fill in the client's current address. This helps to establish a communication line for follow-up.
4. Indicate whether the client has been committed, their race, and insurance information. This data is crucial for understanding the client’s background and insurance coverage.
5. Document the client's phone number and any personal medical identifiers (PMI) that may facilitate their care process.
6. List contact persons or family members, including their roles in the client’s support network and relevant healthcare providers such as psychiatrists or therapists.
7. Answer the questions regarding the problems being experienced that necessitate this level of care, and indicate if the person is willing to accept voluntary treatment.
8. Outline the goals for attending, any risky behaviors, mental health diagnoses, and history of violence or sexual offenses. This section is vital for understanding the client’s needs and risks.
9. Detail the client's level of functioning, brief history, medications, and any physical limitations or issues they may have.
10. Attach any required documents, including a signed health and physical exam, signed orders, and the current medication administration record (MAR).
11. For staff only, complete the sections regarding patient rights, advanced directives, program guidelines, intake scheduling, strengths and vulnerabilities, and cultural considerations.
12. Finally, review all provided information for accuracy. Save the completed form for your records, and utilize options to download, print, or share the document as needed.

Complete your Crisis/IRTS Assessment & Referral Form online today to ensure timely support.