Get Primary Care Communication Consent Form - Meridian ...

Completing the Primary Care Communication Consent Form - Meridian is a crucial step in ensuring effective communication between mental health professionals and primary care providers. This guide will walk you through each section and field of the form to help you navigate the process smoothly and accurately.

Follow the steps to complete your form effortlessly.

1. Press the ‘Get Form’ button to access the Primary Care Communication Consent Form and open it in your preferred PDF editor.
2. In the first section, you will see a space to write your name as the patient. Enter your full name clearly, ensuring all personal information is correct.
3. Next, indicate your authorization for communication with your primary care provider (PCP). Check the corresponding box to signify whether you do or do not authorize this communication.
4. Provide the name of your PCP in the designated field, ensuring you include their title (e.g., Dr.) to maintain professionalism.
5. Next, you will need to sign and date the form. If you are a guardian filling out the form for a minor or another person, indicate your relationship before signing.
6. Move to the section labeled ‘To be completed by therapist.’ Enter the patient’s name and date of birth in the provided fields.
7. Fill in details about the referral by writing the name of the individual who referred the patient and providing the purpose of the assessment.
8. In this section, list any diagnoses (DX) if applicable and detail the treatment plan. Check the appropriate boxes for the type of therapy being utilized.
9. If additional treatments or referrals are necessary, write them in the space provided, ensuring all descriptions are clear and complete.
10. Conclude by signing and dating the form on behalf of the therapist, ensuring that accurate and response-centric communication can commence.
11. Finally, save your changes, and you can choose to download, print, or share the completed form as necessary.

Start filling out your Primary Care Communication Consent Form - Meridian online today!