Get Behavioral Health Partial Program - Mclean Hospital

The Behavioral Health Partial Program at McLean Hospital is a structured treatment option designed to support individuals in need of mental health services. This guide provides a clear overview of how to complete the referral form necessary for participation in this program.

Follow the steps to successfully complete the online form.

1. Press the ‘Get Form’ button to retrieve the Behavioral Health Partial Program form and open it in your chosen digital format.
2. Begin filling out the form by entering the date of referral at the designated field.
3. Provide personal information including your full name, date of birth, address, telephone number, cell phone number, email, and occupation in the respective fields.
4. Indicate the name and phone number of the person who referred you in the ‘Referred By’ section.
5. Fill in your primary insurance information, including subscriber name, ID number, and contact number for benefit verification.
6. If applicable, provide details for secondary insurance and the subscriber's information.
7. List any psychiatric and medical diagnoses as well as the reasons for needing a higher level of care.
8. Outline your goals for the Behavioral Health Partial Program in the appropriate section.
9. Describe your current living situation and select how you will commute to the program (car or public transportation).
10. Document any psychiatric or detox hospitalizations in the past two years, including the facility names.
11. Detail your history of substance abuse, including types and frequency, and indicate willingness to maintain sobriety.
12. Record your current height and weight, as well as any current medications and dosages.
13. Confirm whether you are adherent to prescribed medications and note any allergies.
14. Provide information regarding your current outpatient treatment team, including psychiatrists, therapists, and any other relevant contacts.
15. Discuss any history of suicide attempts or self-injurious behavior, and specify if you have access to firearms.
16. Indicate your current safety status and legal status, providing details if necessary.
17. Lastly, review the required documents that need to be forwarded and ensure a clinician signature is included before submission.
18. Once all information is complete, you can save changes, download, print, or share the filled form.

Start filling out your Behavioral Health Partial Program form online today.