Get Nj Bridgeway Behavioral Health Services Referral Form - Sussex Community Support Team 2021

This guide provides clear and supportive instructions on filling out the NJ Bridgeway Behavioral Health Services Referral Form for the Sussex Community Support Team. Completing this form accurately is crucial for ensuring that the individual receives the appropriate services and support they need.

Follow the steps to complete the referral form online.

1. Press the ‘Get Form’ button to access the referral form and open it in your preferred editing tool.
2. Enter the referral date in the designated field to indicate when the referral is being made.
3. Fill in the referring party’s information, including the name and agency in the ‘Referred By’ section.
4. Provide the individual's full name and date of birth in the appropriate fields.
5. List the individual's address, including street address, city, state, and ZIP code.
6. Input the individual's Social Security number, cell phone number, and home phone number for contact purposes.
7. Complete the referring contact person's information, including their name and phone number.
8. State the reason for the referral clearly in the provided space.
9. Select the services requested by checking the appropriate boxes, detailing the need for case management, PATH, supported housing, partial care, or supported employment.
10. Include any relevant comments that may help clarify the individual's situation or needs.
11. Fill out the income source and insurance information, including Medicaid or Medicare details as applicable.
12. Ensure to attach any required records, such as intake assessments or treatment plans, as specified.
13. Detail any psychiatric or medical diagnoses, current medications, and treatment team members in the appropriate sections.
14. Provide information on psychiatric hospitalizations, medical issues, substance abuse history, legal involvement, and any history of suicidality.
15. Once all fields are completed, you can save your changes, download the form, print it, or share it through appropriate channels.

Begin filling out your referral form online today to connect individuals with the support they need.