Follow the steps to complete the form online.

1. Click ‘Get Form’ button to access the form and open it in your document editor.
2. Begin by filling out the 'Referring Party Information' section. Provide your name, relationship to the candidate, date of birth (if applicable), agency or hospital name (if relevant), and your contact phone number.
3. Next, complete the 'Candidate Information' section. Enter the candidate's last name, first name, gender, height, weight, hair color, current living situation, phone numbers, Social Security number, address, race or ethnicity, and primary language.
4. Detail any immediate safety concerns regarding the candidate in the 'Immediate Safety Concerns' section. Describe any concerning behaviors you have observed and attach additional sheets if more space is required.
5. In the 'Treatment Information' section, provide reasons for your belief that the candidate is at risk of further deterioration and that they have not accepted voluntary treatment. Again, use additional sheets if more information is necessary.
6. Indicate whether you believe the candidate should be in a psychiatric hospital or locked facility and provide your reasoning. Use additional sheets for extended explanations if needed.
7. Fill out questions regarding psychiatric problems, significant medical problems, current mental health treatment, presence of substance abuse, treatment history, and compliance with treatment. Attach additional sheets as needed.
8. Provide information about the candidate's history of psychiatric hospitalization and/or incarceration. Note any attempts of suicide or history of violence, and any interactions with law enforcement or frequent emergency room visits.
9. Once you have completed the form, review all entries for accuracy and completeness. You can then save your changes, download, print, or share the form as needed.

Take action now and fill out the CA LACDMH AOT Candidate Referral Form online to ensure timely processing of your referral.