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Psychiatric Referral Summary PRINT CLIENT NAME DATE OF BIRTH AGE GENDER Male ADDRESS CITY STATE Female ZIP CODE SUPPORTING AGENCY CONTACT PERSON TELEPHONE NUMBER LEGAL REPRESENTATIVE TELEPHONE NUMBER

How to fill out psychiatric referral summary

How to fill out a psychiatric referral summary:

1. Start by gathering all necessary information about the patient, including their personal details, medical history, and current symptoms.
2. Include a brief summary of the patient's chief complaint and the reason for the referral to a psychiatrist.
3. Provide a detailed account of the patient's psychiatric history, including any previous diagnoses, medications, treatments, and hospitalizations.
4. Include information about the patient's current mental health status, such as their current symptoms, any suicidal or homicidal ideation, and any previous attempts.
5. Document any relevant physical health conditions or medications that may impact the patient's mental health.
6. Include information about the patient's social support system, including family dynamics and relationships, living situation, and any significant life events or stressors.
7. Briefly summarize any previous psychiatric assessments or evaluations that have been conducted and include the findings and recommendations.
8. Indicate the reasons for the referral to a psychiatrist, such as a need for medication management, therapy, or a more specialized evaluation.
9. Offer any specific concerns or questions you may have regarding the patient's mental health or the referral process.
10. Sign and date the referral summary.

Who needs a psychiatric referral summary:

A psychiatric referral summary is typically needed when a healthcare provider, such as a primary care physician, therapist, or counselor, believes that a patient would benefit from a psychiatric evaluation or specialized mental health treatment. It is also necessary for insurance purposes and to provide a comprehensive overview of the patient's mental health history and current needs to the psychiatrist.

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