Contra Costa MHC113 2013 free printable template
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NAME/MAN: BEHAVIORAL HEALTH DIVISION INITIAL PSYCHIATRIC ASSESSMENT DATE OF SERVICE STAFF # Code Activity: 361 EVIL/RX Location: RU# HOURS MINUTES 1 Office 2 Field 4 Home 5 School Satellite 18 Other
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How to fill out Contra Costa MHC113
01
Begin by gathering all necessary personal information, including your full name, address, date of birth, and contact information.
02
Review the purpose of the form and any required documentation that needs to accompany it.
03
Fill in the 'Section A' by providing detailed information about your mental health history.
04
Move on to 'Section B' to describe your current mental health concerns or conditions.
05
Complete 'Section C' by noting any medications you are currently taking, along with dosages.
06
If applicable, fill out 'Section D' regarding previous assessments or treatments you've undergone.
07
Carefully read through all sections to ensure accuracy in the information provided.
08
Sign and date the form at the designated area to confirm that the information is correct to the best of your knowledge.
09
Submit the completed form through the appropriate channel as instructed.
Who needs Contra Costa MHC113?
01
Individuals seeking mental health services or support in Contra Costa County.
02
Patients who have been referred for mental health assessment or treatment.
03
Families or caregivers looking to advocate for individuals needing mental health resources.
04
Anyone requiring a comprehensive evaluation of their mental health needs.
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What is Contra Costa MHC113?
Contra Costa MHC113 is a form or document used for reporting certain information related to mental health services in Contra Costa County, California.
Who is required to file Contra Costa MHC113?
Entities or individuals providing mental health services in Contra Costa County are required to file Contra Costa MHC113.
How to fill out Contra Costa MHC113?
To fill out Contra Costa MHC113, you must provide the necessary details such as service dates, type of services rendered, and client information, following the specific instructions included with the form.
What is the purpose of Contra Costa MHC113?
The purpose of Contra Costa MHC113 is to collect and report data necessary for the planning and evaluation of mental health services in the county.
What information must be reported on Contra Costa MHC113?
The information that must be reported includes client demographics, types and amounts of services provided, and outcomes or measurements of service effectiveness.
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