Get (pact) Referral Form - Mclean Hospital

Filling out the Program of Assertive Community Treatment (PACT) Referral Form online is a crucial step for individuals seeking support. This guide offers clear instructions on how to complete each section of the form to ensure accurate and efficient submission.

Follow the steps to complete your (PACT) Referral Form accurately.

1. Press ‘Get Form’ button to access the referral form and open it in your preferred document editor.
2. Begin by filling in the Demographics section, which includes the client’s name, phone number, date of birth, age, sex, preferred pronouns, marital status, and address. Ensure all information is accurate and complete.
3. In the Demographics section, specify the commute time from the client's residence to McLean Hospital according to Google Maps. Note who the client lives with and how long they have resided at that address.
4. Next, provide details for the Primary Family/Emergency Contact section, including their name and phone number, along with any guardian information if applicable.
5. Move to the Referral Information section, where you identify yourself as the person completing the form, your relationship to the client, and any relevant clinic or institution affiliations. Mark all applicable reasons for the referral, and clarify if both the client and their support system are interested in PACT services.
6. Proceed to the Current Clinical Information section. Describe the client's current clinical presentation, including symptoms and any current diagnosis. List current medications, including dosage, and indicate whether the client adheres to the prescribed regimen.
7. Under Current Medical Issues, provide information about other medical conditions and any substance use history, detailing frequency of use as necessary.
8. Complete the Historical Clinical Information section by documenting prior levels of care engaged, psychiatric admissions, any legal history, and experiences with trauma.
9. In the Psychosocial Functioning section, describe family dynamics, any known domestic violence, and other social supports or community involvement.
10. Discuss financial responsibility and whether the responsible party has been informed about financial expectations.
11. Provide your recommendations for PACT services based on the client’s needs, selecting the most beneficial services and suggesting a preferred start date.
12. Once all sections are completed, review the form for accuracy, save your changes, and prepare to submit the referral via fax or postal mail as outlined at the end of the document.

Begin filling out your (PACT) Referral Form online to ensure timely support.