Get the free DMH REFERRAL EMERGENCY INFORMATION FORM

LIFESTYLES REFERRAL Please fill out and return to: Kerry Roberts Southwest Suburban 5 Randolph Street, Canton MA 02021 Tel # 7814019716 Fax: 7814019721 1. Client Name: 3. Date of Birth: 5. Current

How to fill out dmh referral emergency information

Who needs dmh referral emergency information?

1. Any individual seeking mental health services through the Department of Mental Health (DMH) may need to provide referral emergency information. This includes individuals experiencing a mental health crisis or those seeking assistance for themselves or a loved one.
2. People who have been referred to DMH by a healthcare professional, such as a physician, therapist, or counselor, may also need to fill out the referral emergency information. This ensures that DMH has essential information about the individual's emergency contacts, medical history, and any current crisis situations.

How to fill out dmh referral emergency information:

1. Start by obtaining the necessary forms from the DMH office or their website. These forms are usually available for download or can be picked up at the DMH facility. Make sure to use the most updated version of the form.
2. Read the instructions provided with the form carefully. This will help you understand what information needs to be provided and any specific guidelines for filling out the form.
3. Begin by filling out your personal information accurately. This may include your full name, date of birth, address, contact information, and social security number. Double-check these details to ensure they are correct.
4. The form will likely have a section for emergency contacts. Include the names, relationships, and contact information of people who should be notified in case of an emergency related to your mental health. It is essential to provide accurate and up-to-date contact information for these individuals.
5. Provide details of your current mental health crisis. This may include information about any suicidal thoughts, self-harm tendencies, or specific symptoms you are experiencing. Be honest and thorough when describing your situation, as this will help the DMH professionals understand your needs better.
6. Some forms may require you to fill in your medical history, including any medications you are currently taking and any previous psychiatric hospitalizations or treatments. Gather this information beforehand to ensure its accuracy.
7. Review the completed form before submission. Check for any missing or incomplete information and make corrections if necessary. It is crucial to ensure the form is filled out completely and accurately.
8. Once you have filled out the form, submit it to the designated DMH office or follow any additional instructions provided. Keep a copy of the form for your records in case you need to reference it in the future.

Remember, the process of filling out DMH referral emergency information may vary depending on your location and the specific requirements of your local DMH office. It is always best to consult the instructions provided with the form or reach out to the DMH office directly if you have any questions or need clarification.

For pdfFiller’s FAQs

How do I execute dmh referral emergency information online?

pdfFiller has made filling out and eSigning dmh referral emergency information easy. The solution is equipped with a set of features that enable you to edit and rearrange PDF content, add fillable fields, and eSign the document. Start a free trial to explore all the capabilities of pdfFiller, the ultimate document editing solution.

How do I make edits in dmh referral emergency information without leaving Chrome?

dmh referral emergency information can be edited, filled out, and signed with the pdfFiller Google Chrome Extension. You can open the editor right from a Google search page with just one click. Fillable documents can be done on any web-connected device without leaving Chrome.

How do I edit dmh referral emergency information on an iOS device?

No, you can't. With the pdfFiller app for iOS, you can edit, share, and sign dmh referral emergency information right away. At the Apple Store, you can buy and install it in a matter of seconds. The app is free, but you will need to set up an account if you want to buy a subscription or start a free trial.

What is dmh referral emergency information?

dmh referral emergency information is a form used to report emergency contact information for individuals receiving services from the Department of Mental Health.

Who is required to file dmh referral emergency information?

Providers and facilities that offer services to individuals under the Department of Mental Health are required to file dmh referral emergency information.

How to fill out dmh referral emergency information?

Dmh referral emergency information can be filled out by providing the necessary contact information for emergency situations, such as name, relationship, phone number, and any other relevant details.

What is the purpose of dmh referral emergency information?

The purpose of dmh referral emergency information is to ensure that in case of emergencies, the Department of Mental Health has access to the necessary contact information to reach out to individuals receiving services.

What information must be reported on dmh referral emergency information?

On dmh referral emergency information, information such as the individual's name, relationship to the contact person, phone number, and any relevant details about medical conditions or special needs should be reported.