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Get Ca Tay Fsp Referral/notification 2017-2025
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How to fill out the CA TAY FSP Referral/Notification online
The CA TAY FSP Referral/Notification form is an essential document aimed at facilitating mental health services for transition-age youth. This guide will provide you with a clear and supportive overview of how to complete this form online, ensuring that you have all the information needed for a smooth submission process.
Follow the steps to fill out the CA TAY FSP Referral/Notification form online:
- Press the ‘Get Form’ button to access the CA TAY FSP Referral/Notification form and open it in your preferred document editor.
- Begin by filling out the Referral Information section. Provide the recipient's DMH IS/IBHIS number, Social Security Number, and date. Enter the first and last name, date of birth, preferred language, race/ethnicity, age, contact address, and gender.
- Continue to input the individual's current living situation, phone number, and insurance details. Check the appropriate insurance options that apply, including Medi-Cal, Healthy Families, or others.
- In the Referral Source section, fill out the agency name, contact person, phone number, fax, and email. Indicate whether the individual is currently receiving mental health services from your agency or any other agency involvement, and provide details if applicable.
- Under Level of Service, indicate the client's previous mental health service history by checking the appropriate box. Include any necessary details regarding the individual’s recent mental health services if they have been received within six months.
- In the Diagnostic Considerations section, specify the primary ICD-10 diagnosis and check all applicable items related to the individual's mental health status. Provide detailed explanations for any checked items.
- Proceed to the Focal Population section and check whether the client meets section A or B criteria, depending on the scenario. Include the enrollment date as required.
- Complete the remaining sections by ensuring that all required fields are filled out accurately and succinctly, reflecting comprehensive information that may aid the referral process.
- Once all information is accurately filled in, review the form for any errors or omissions. After ensuring that all fields are complete, save your changes, then download, print, or share the completed form as necessary.
Complete the CA TAY FSP Referral/Notification form online today!
A FSP, or Flexible Spending Program, represents a financial strategy allowing people to utilize their pre-tax earnings for essential expenses. Such programs are essential in healthcare planning and budgeting. By utilizing the CA TAY FSP Referral/Notification service, individuals can streamline applying for benefits and ensure they access the care they deserve.
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