Get the free Case Management Referral Form - hcmha

This form is used for referring individuals to the Howard County Mental Health Authority for case management services, collecting personal, legal, and clinical information necessary for eligibility

How to fill out case management referral form

How to fill out Case Management Referral Form

1. Obtain the Case Management Referral Form from the relevant agency or website.
2. Fill in the basic information section: include the client's name, date of birth, and contact information.
3. Provide details regarding the referral source: include the name of the person or organization making the referral.
4. Describe the reason for the referral thoroughly: include specific concerns or issues that warrant case management.
5. Specify any immediate needs: highlight critical services or assistance required by the client.
6. Include any relevant background information: summarize previous assessments, services accessed, and any other pertinent history.
7. Ensure all sections of the form are completed accurately to avoid processing delays.
8. Review the form for accuracy and completeness before submission.
9. Submit the form according to the agency's guidelines, whether by email, fax, or in person.

Who needs Case Management Referral Form?

1. Individuals who are experiencing complex needs or challenges that require coordinated support services.
2. Families in crisis or needing assistance with various social services.
3. Clients transitioning between different types of care, such as medical to social services.
4. Individuals facing barriers to accessing essential services, such as housing or healthcare.

People Also Ask about

What is a core function of case management?

Case management goes from the identification and engagement of patients/clients through the assessment and care planning steps and culminating in monitoring the care described in the care plan and ultimately achieving the targeted outcomes in a measurable manner.

What are the 7 core functions of case management?

Case management consists of the following seven steps: Screening and case intake. Assessment and evaluation. Risk evaluation. Plan and establish goals. Implementation. Monitoring and review. Outcome evaluation.

What are the basic functions of case management?

Case management is a collaborative process of assessment, planning facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost

What are the 6 core tasks of the case management process?

The 6 Core Tasks of the Case Management Process 1) Screening. The first step of the process is determining if the case in question requires the case management services in the first place. 2) Assessing. 3) Risk evaluation. 4) Planning. 5) Implementation. 6) Outcome evaluation.

When to refer to case management?

Generally, patients with complex problems and considerable medical expenses receive case management support. Problems may be one or a combination of medical, social, financial or mental health.

What are the 9 steps of the case management process?

The Case Management Process consists of nine phases through which case managers provide care to their clients: Screening, Assessing, Stratifying Risk, Planning, Implementing (Care Coordination), Following-Up, Transitioning (Transitional Care), Communicating Post Transition, and Evaluating.

What are referrals in case management?

A referral for case management is appropriate when a provider encounters a child who has a health condition or risk and needs help with accessing health-related resources and services, educational services, vocational services, psychosocial services, financial assistance, or transportation services.

What are the 4 pillars of case management?

This collaborative process involves assessment, planning, plan implementation, and evaluation to successfully achieve the client's desired outcome.

For pdfFiller’s FAQs

What is Case Management Referral Form?

The Case Management Referral Form is a document used to formally refer an individual or case to a case management program for assessment, planning, and coordination of care.

Who is required to file Case Management Referral Form?

Typically, the form is required to be filed by healthcare providers, social workers, or agencies that identify individuals in need of case management services.

How to fill out Case Management Referral Form?

To fill out the Case Management Referral Form, provide relevant details about the individual, including personal information, the reason for referral, and any specific needs or concerns. Ensure that all sections are completed accurately.

What is the purpose of Case Management Referral Form?

The purpose of the Case Management Referral Form is to initiate the process of case management services, ensuring that individuals receive the appropriate resources and support tailored to their needs.

What information must be reported on Case Management Referral Form?

The information that must be reported includes the individual's basic demographic information, the nature of their situation, specific needs, and any relevant medical or social history that could assist in managing their care.