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Los Angeles Unified School District STUDENT HEALTH AND HUMAN SERVICES SCHOOL MENTAL HEALTH SMH Referral Cover Sheet SelfReferral (Ages 12 and up) DATE: From: Name/Title Email address: Telephone Number(s):

How to fill out smh referral cover sheet

How to fill out smh referral cover sheet:

1. Start by gathering all the necessary information for the referral, including the patient's personal details, medical history, and reason for the referral.
2. Identify the referring healthcare provider by providing their name, contact information, and any relevant identification numbers.
3. Specify the referred healthcare provider or facility by including their name, address, contact information, and any necessary identification numbers.
4. Fill in the date of the referral and indicate the urgency or priority level, if applicable.
5. Include any additional instructions or notes related to the referral, such as specific tests or procedures required.
6. Ensure that all the information provided is accurate and complete before submitting the referral cover sheet.

Who needs smh referral cover sheet:

1. Healthcare providers who need to refer their patients to other specialists or healthcare facilities.
2. Patients who require specialized care or services that cannot be provided by their primary healthcare provider.
3. Insurance companies or third-party payers who require documentation of the referral for coverage purposes.

For pdfFiller’s FAQs

What is smh referral cover sheet?

The SMH referral cover sheet is a document used to refer patients to mental health services.

Who is required to file smh referral cover sheet?

Healthcare professionals such as doctors, psychologists, and therapists are required to file the SMH referral cover sheet when referring patients to mental health services.

How to fill out smh referral cover sheet?

The SMH referral cover sheet can be filled out by providing information about the patient's demographics, reason for referral, symptoms, and any relevant medical history.

What is the purpose of smh referral cover sheet?

The purpose of the SMH referral cover sheet is to ensure smooth and accurate communication between healthcare providers when referring patients to mental health services.

What information must be reported on smh referral cover sheet?

Information such as patient demographics, reason for referral, symptoms, medical history, and contact information for the referring healthcare provider must be reported on the SMH referral cover sheet.

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