Get Ab-1424 Form - Alameda County Behavioral Health - Acphd

Completing the AB-1424 Form is an important step in providing relevant historical information about a person’s mental health from family members or interested parties. This guide will walk you through the process of filling out this form online, ensuring that all necessary details are accurately provided.

Follow the steps to complete the AB-1424 Form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the consumer in the designated field. This is crucial as it identifies the individual whose mental health history is being discussed.
3. Fill in the consumer's date of birth and phone number. Accurate contact information is essential for any needed follow-up.
4. Provide the consumer's address, ensuring completeness for effective communication.
5. Indicate the primary language spoken by the consumer and their religion where applicable.
6. Check the appropriate boxes for Medi-Cal and Medicare status, as well as the name of any private medical insurer, if applicable.
7. Request the consumer's consent by asking them to sign an authorization that allows mental health providers to communicate regarding their care.
8. Indicate how you wish to be contacted in case of emergencies or changes in the consumer's condition.
9. State whether the consumer has a Wellness Recovery Action Plan (WRAP) or an Advance Directive, and attach copies if available.
10. Document the brief history of the consumer's mental illness, including age of onset, any prior 5150 events, hospitalizations, and any history of violence or self-harm. Attach additional pages if necessary.
11. Answer the questions regarding whether the consumer has a conservator and state their name and phone number if applicable.
12. Provide information regarding the consumer’s diagnosis and any known substance abuse issues.
13. List current medications, as well as those the consumer has responded positively or negatively to.
14. Enter details for the treating psychiatrist and case manager, including names and phone numbers.
15. Outline any significant medical conditions and allergies the consumer may have.
16. Describe the current living situation of the consumer, and indicate if it is stable.
17. Complete the information submitted by you, including your name, relationship to the consumer, phone number, and your signature along with the date.
18. Review the form for accuracy before saving your changes. Once finished, ensure you download, print, or share the form as needed.

Start filling out the AB-1424 Form online today to support the mental health care process.