Get San Diego County Case Management Referral Form

The San Diego County Case Management Referral Form is an important document used for accessing vital mental health services. This guide provides clear, step-by-step instructions to ensure that you can successfully complete this form online, facilitating proper referrals for individuals in need.

Follow the steps to complete the referral form efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date of referral in the designated field format (MM/DD/YYYY). This is crucial as it provides a timestamp of when the referral is made.
3. In the 'Name of Person Making Referral' section, write the full name of the person completing the form. This helps identify the source of the referral.
4. Provide the referring agency’s name and address in the respective fields, ensuring the accuracy of contact information.
5. Fill in the phone and fax numbers under the referring party information for communication follow-ups.
6. Complete the identifying information of the person being referred, including their name, last four digits of their social security number, date of birth, and any aliases, to properly identify the individual.
7. Specify the language preference and provide the address and phone number of the person being referred to ensure proper communication and outreach.
8. Indicate whether the person has experienced homelessness by selecting 'Yes' or 'No,' and if applicable, provide the period of homelessness.
9. In the 'Clinical Information' section, answer whether the person is interested in case management, and provide specific reasons for the referral in the space provided.
10. Detail the current problems, barriers, or challenges the person faces, along with their mental health stage of recovery by selecting the appropriate option.
11. Document the history of mental health treatment, hospitalization count in the last two years, and any substance use issues, including the date of last use and substance of choice.
12. Complete the diagnoses section by filling in the necessary diagnostic axes, stressing the importance of comprehensive assessment for effective case management.
13. List any current medical issues and the primary care physician's information to provide a complete health overview.
14. Indicate the legal status, including any conservatorship or incarceration history, which may affect the referral process.
15. Address the financial and insurance information accurately to determine eligibility for services.
16. Finally, ensure to sign and date the form once completed. This confirms the submission and accountability of the referral process.
17. After completing the form, you can save changes, download a copy for your records, print the form, or share it as necessary.

Take the first step towards accessing mental health services by completing the San Diego County Case Management Referral Form online today.