Get Ny Referral Form For Mh Care Management & Act Team Services 2013-2025
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How to fill out the NY Referral Form for MH Care Management & ACT Team Services online
Filling out the NY Referral Form for Mental Health Care Management and Assertive Community Treatment Team Services online can seem daunting. This guide will provide you with clear, step-by-step instructions to ensure a smooth completion of the form, while also emphasizing the importance of accurate information for effective service delivery.
Follow the steps to complete the NY Referral Form online
- Press the 'Get Form' button to gain access to the NY Referral Form, where you can open it for completion.
- Begin by filling in the personal details of the referred individual, including their name, date of birth, gender, and Social Security number. Ensure that all information is accurate and legibly written.
- List the individual's current address, city, state, and zip code. Include valid phone numbers where the individual can be reached.
- Indicate the individual's awareness of the referral and consent to the referral process by checking ‘Yes’ or ‘No’ as appropriate.
- Provide details about the person making the referral, including their name, agency, contact information, and relationship to the referred individual.
- Fill out the income and entitlements section by checking all applicable options to provide a comprehensive understanding of financial support.
- Describe the current living situation and custody status, marking whether the individual has children or is experiencing homelessness.
- Detail the individual's educational background and current vocational or educational activities, along with language proficiencies.
- In the psychiatric information section, provide any current diagnoses, medications, and describe any significant medical conditions.
- Complete the reason for referral by specifying the areas in which the referred individual is experiencing functional limitations and their current situation.
- Before submitting, review all sections thoroughly to prevent missing information that could delay the referral process. You can save changes, download, print, or share the completed form.
Begin the process of filling out your NY Referral Form online today!
The ACT team, or Assertive Community Treatment team, in New York State provides comprehensive support for individuals with severe mental illness. This mobile treatment team includes professionals from various disciplines who collaborate to deliver personalized care. By focusing on the individual’s unique needs, they help improve daily living skills and facilitate community integration, ensuring clients receive the right support. To get started, you can complete the NY Referral Form for MH Care Management & ACT Team Services.
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