Get the free MHSU INTAKE REFERRAL FORM - divisionsbcca

MHSC INTAKE REFERRAL FORM Referral Date: Referral Person/Agency: Phone: Fax: CLIENT NAME: Gender: Address: Birth date: Client aware of referral? Phone: Substance Use Criminal History: Yes Risk to

How to fill out mhsu intake referral form

How to Fill Out MHSU Intake Referral Form:

1. Start by gathering all the necessary information and documents you will need to complete the form. This may include personal identification, contact information, medical history, and any relevant referral or assessment information.
2. Begin by filling out the basic information section of the form. This usually includes your full name, date of birth, address, phone number, and email address. Ensure that all the information provided is accurate and up to date.
3. Move on to the next section, which typically asks for your primary care provider's information. Include their name, clinic or hospital name, phone number, and any additional relevant details requested.
4. Proceed to the section where you will provide your medical history. This may involve answering questions about previous diagnoses, current medications, past treatments, and any known allergies. Be thorough and provide as much detail as possible.
5. If applicable, there may be a section related to your mental health history. Describe any prior mental health conditions, treatments, hospitalizations, or medications in detail. The more information you provide, the better the mental health professionals can understand your situation.
6. Some forms also ask about your current living situation or any support systems you have in place. This could include questions about your housing, employment, family support, or involvement with social services. Answer honestly and provide accurate details.
7. If you have received a referral from another healthcare professional or organization, ensure that you include their information and any relevant referral documentation. This can help streamline the intake process and ensure smooth coordination of care.
8. Finally, review the completed form for any errors or missing information. Make sure that all the sections have been answered and that you have provided all the necessary documentation. It's important to double-check all the details before submitting the form to avoid any delays or complications.

Who Needs MHSU Intake Referral Form:

1. Individuals seeking mental health or substance use services may need to fill out the MHSU intake referral form. This form acts as a gateway for accessing specialized care and treatment.
2. Healthcare professionals, such as primary care providers or therapists, may also need to complete the form when referring a patient to MHSU services. It serves as a means to ensure appropriate and coordinated care for the individual.
3. Community organizations or social service agencies may require the form when connecting their clients with mental health and substance use resources provided by MHSU. This helps facilitate the referral process and ensures continuity of care.

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What is mhsu intake referral form?

The mhsu intake referral form is a document used to refer individuals to mental health and substance use services.

Who is required to file mhsu intake referral form?

Healthcare providers, social workers, and other professionals who are working with individuals in need of mental health and substance use services are required to file the mhsu intake referral form.

How to fill out mhsu intake referral form?

The mhsu intake referral form can be filled out by providing relevant information about the individual in need, their current situation, and the type of services required.

What is the purpose of mhsu intake referral form?

The purpose of the mhsu intake referral form is to connect individuals in need of mental health and substance use services with the appropriate resources and support.

What information must be reported on mhsu intake referral form?

Information such as the individual's name, contact information, current mental health and substance use issues, and any relevant medical history must be reported on the mhsu intake referral form.