Get the free Neurobehavioral Testing Unit Referral Form - Mental Health

County of Orange Health Care Agency Behavioral Health Services Center of Excellence Neurobehavioral Testing Unit Referral Form Mental Health Client Name: Age: Date of Birth: Ethnicity: Phone Number:

How to fill out neurobehavioral testing unit referral

How to fill out neurobehavioral testing unit referral:

1. Begin by providing your personal information such as your name, address, contact number, and date of birth.
2. Next, include your healthcare provider's information including their name, address, and contact details.
3. Specify the reason for the referral, detailing any symptoms or concerns you are experiencing that warrant the need for neurobehavioral testing.
4. If necessary, provide a brief medical history, highlighting any relevant medical conditions or previous treatments.
5. If you have any specific preferences or requirements for the testing, such as a preferred date or time, make sure to mention them in the referral.
6. Finally, sign and date the referral form before submitting it to the neurobehavioral testing unit.

Who needs neurobehavioral testing unit referral:

1. Individuals who are experiencing cognitive or behavioral difficulties that may require further evaluation and assessment.
2. Those who have been diagnosed with neurological conditions such as Alzheimer's disease, traumatic brain injury, or attention deficit hyperactivity disorder (ADHD), and require specialized testing to understand their symptoms better.
3. Patients who have undergone neurological treatments or surgeries and need to monitor their progress or assess any potential complications.
4. Individuals who have a family history of neurobehavioral disorders and want to proactively evaluate their own cognitive functioning.
5. Healthcare providers who suspect neurobehavioral issues in their patients and want to refer them to specialists for further evaluation and guidance.

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What is neurobehavioral testing unit referral?

Neurobehavioral testing unit referral is a process where individuals are referred to a specialized unit for assessment of their cognitive, emotional, and behavioral functioning.

Who is required to file neurobehavioral testing unit referral?

Healthcare professionals, psychologists, and psychiatrists are required to file neurobehavioral testing unit referrals.

How to fill out neurobehavioral testing unit referral?

Neurobehavioral testing unit referrals can be filled out by providing relevant information about the individual's symptoms, medical history, and reason for referral.

What is the purpose of neurobehavioral testing unit referral?

The purpose of neurobehavioral testing unit referral is to assess and diagnose cognitive, emotional, and behavioral disorders in individuals.

What information must be reported on neurobehavioral testing unit referral?

The information reported on neurobehavioral testing unit referral includes the individual's personal details, symptoms, medical history, and reason for referral.