Get the free Crisis Referral Form

Crisis Referral Form Nearest Hospital (with Emergency Department) Name:Address:Phone: Triage:Crisis Assessment and Treatment services Name of CAT team:CAT team contact person:Phone:Additional phone

How to fill out crisis referral form

How to fill out a crisis referral form:

1. Start by obtaining a crisis referral form from the appropriate source. This may be a mental health clinic, a hospital, or any other organization that deals with crisis situations.
2. Read through the form carefully to familiarize yourself with the information and sections that need to be completed. Pay attention to any instructions or guidelines mentioned.
3. Begin by filling out your personal information accurately. This may include your full name, contact information, date of birth, and address. Make sure to double-check the accuracy of this information as it is essential for follow-up.
4. If the form requires you to provide information about the crisis or the reason for referral, be as detailed and specific as possible. Include relevant dates, events, and any additional information that may help the referral agency understand the situation better.
5. Take note of any sections that require you to provide information about your current mental or physical health. This may include disclosing any medications you are currently taking, past medical history, or any relevant diagnoses.
6. If the form includes a section for emergency contacts, make sure to provide accurate and up-to-date contact information for individuals who should be contacted in case of an emergency.
7. If there is a section for your preferred language or any accommodations you may need, make sure to fill it out accordingly. This will ensure that the referral agency is aware of any specific needs you may have.
8. Once you have completed all the necessary sections of the form, review it one final time to ensure all information is accurate and legible. Make any necessary corrections or additions before submitting it.

Who needs a crisis referral form:

1. Individuals who are currently experiencing a mental health crisis and require immediate assistance.
2. Individuals who may be at risk of harming themselves or others and need professional intervention.
3. People who have witnessed or are involved in a traumatic event and need support or guidance in coping with the aftermath.
4. Individuals who have been referred by a healthcare professional or a counselor for specialized crisis intervention or treatment.
5. Those who believe they may benefit from crisis services such as counseling, therapy, or emergency mental health support.

Note: It is important to consult the specific organization or facility providing the crisis referral form to determine if you meet their criteria for accessing their services.

For pdfFiller’s FAQs

What is crisis referral form?

The crisis referral form is a document used to report an urgent situation that requires immediate attention and intervention.

Who is required to file crisis referral form?

The crisis referral form may be filed by healthcare professionals, social workers, law enforcement, or any individual who becomes aware of a crisis situation.

How to fill out crisis referral form?

To fill out a crisis referral form, one must provide detailed information about the crisis situation, including individuals involved, location, and any relevant background information.

What is the purpose of crisis referral form?

The purpose of the crisis referral form is to alert the appropriate authorities or agencies about a crisis situation so that prompt and appropriate action can be taken to address it.

What information must be reported on crisis referral form?

The crisis referral form must include details such as the nature of the crisis, individuals involved, location, and any known risk factors or safety concerns.

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