Get the free FUM209-Continued Outpatient Mental Health Treatment Request Formdoc

Phone: 800-868-1032 Fax: 803-714-6456 www.CompanionBenefitAlternatives.com Continued Outpatient Mental Health Treatment Request * required information Clinician s First Name*: Licensure*: Fax*: Mailing

How to fill out fum209-continued outpatient mental health

How to Fill out FUM209-Continued Outpatient Mental Health:

1. Start by entering your personal information, including your full name, date of birth, and contact information. This will ensure that the form is properly identified and connected with your medical records.
2. Provide details about your current outpatient mental health treatment. Include the name and contact information of your treating healthcare provider, as well as the dates and frequency of your appointments.
3. Indicate the reason for seeking continued outpatient mental health care. Describe your current mental health condition or symptoms, any progress or changes you have experienced since starting the treatment, and the goals you hope to achieve through continued care.
4. Identify any medications you are currently taking or have been prescribed for your mental health condition. Include the name of the medication, dosage, frequency, and any side effects or issues you may have encountered.
5. Specify any additional treatments or therapies that have been recommended or prescribed as part of your outpatient mental health care. This could include psychotherapy, group therapy, or other interventions aimed at improving your mental well-being.
6. Provide information about any current or previous hospitalizations related to your mental health condition. Include the dates, name of the facility, and reasons for admission, if applicable.
7. Indicate any changes in your personal circumstances or resources that may impact your ability to access or continue with outpatient mental health care. This could include changes in insurance coverage, financial difficulties, or other barriers to treatment.

Who Needs FUM209-Continued Outpatient Mental Health:

1. Individuals who are currently receiving outpatient mental health treatment and wish to continue this care.
2. Patients with a diagnosed mental health condition who require ongoing monitoring, support, and treatment to manage their symptoms effectively.
3. Individuals who have previously received inpatient mental health care and are transitioning to outpatient care as part of their recovery process.

Remember, filling out FUM209-Continued Outpatient Mental Health accurately and thoroughly is crucial for ensuring the continuation of appropriate care and support for your mental health needs.

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