NC DMH 1-73-00 2007 free printable template
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Facility Medical Record #: Last 4 of SSN: Admitting State Hospital/ADAC: DATE: TIME: NC DIVISION OF MENTAL HEALTH/DEVELOPMENTAL DISABILITIES/SUBSTANCE ABUSE SERVICES Regional Referral Form for Admission
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How to fill out NC DMH 1-73-00
01
Step 1: Begin by gathering all necessary personal information, including name and contact details.
02
Step 2: Fill in the demographic information section, ensuring accuracy in your entries.
03
Step 3: Complete the assessment questions as honestly as possible, providing detailed responses where applicable.
04
Step 4: Review your filled-out form for any errors or missing information.
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Step 5: Sign and date the form at the designated area before submission.
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Step 6: Submit the form to the appropriate department or office indicated in the instructions.
Who needs NC DMH 1-73-00?
01
Individuals seeking mental health services in North Carolina.
02
Professionals referring clients to mental health services.
03
Organizations involved in mental health assessments or services.
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What is NC DMH 1-73-00?
NC DMH 1-73-00 is a form used by the North Carolina Department of Mental Health to collect data related to mental health services and client information.
Who is required to file NC DMH 1-73-00?
Mental health service providers in North Carolina who receive state funds are required to file NC DMH 1-73-00.
How to fill out NC DMH 1-73-00?
To fill out NC DMH 1-73-00, providers must gather required client data, complete all sections of the form accurately, ensure compliance with confidentiality regulations, and submit it according to the specified guidelines.
What is the purpose of NC DMH 1-73-00?
The purpose of NC DMH 1-73-00 is to ensure the proper collection and reporting of data related to mental health services, which helps in planning, evaluating, and improving mental health programs in North Carolina.
What information must be reported on NC DMH 1-73-00?
The information that must be reported on NC DMH 1-73-00 includes client demographic details, service types provided, billing information, and relevant clinical data.
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