Get Mclean At Naukeag Ambulatory Treatment Program Self-refferral Packet 2013

Filling out the McLean at Naukeag Ambulatory Treatment Program Self-Referral Packet is an important step in seeking treatment. This guide provides clear, step-by-step instructions to help you complete the form online effectively.

Follow the steps to fill out the self-referral packet with ease.

1. Click the ‘Get Form’ button to obtain the self-referral packet and open it for completion.
2. Complete the patient information section including your name, age, gender, date of birth, address, email, and phone numbers. Indicate if you have been to Naukeag previously and how you heard about the program.
3. In the presenting problem section, check all boxes that reflect your current issues. Additionally, provide a brief statement about why you are considering admission.
4. Fill out the current treatment section by indicating whether you have current treatment providers and if you have a psychiatric diagnosis. List the names and contact details of your treatment providers.
5. In the drug use history section, provide information about your primary and secondary drug use. Include details such as age of first use, last use, frequency, and amount for each substance.
6. List all current medications, including dosage and reasons for taking them in the medications section.
7. Complete the risk factors section, noting if you have a history of suicidal attempts, self-harm, or trauma.
8. If applicable, fill out the legal section, indicating any current legal charges or probation status.
9. Detail your aftercare plans, including housing and treatment options post-admission.
10. Provide any additional comments in the designated section and ensure all required fields are filled out accurately.
11. Once the form is complete, save your changes, and choose to either download, print, or share the form as needed.

Take the next step towards your treatment by completing the self-referral packet online today.