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Page 1 of 2 ADULT PARTIAL HOSPITALIZATION PROGRAM 2617 West Henrietta Road Rochester, NY 14623 Phone (585× 2767620 Fax (585× 2562805 REFERRAL FORM Please print clearly or type PATIENT: DOB: Address:
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How to fill out a partial hospitalization program in Rochester:

01
Start by gathering all necessary documents and information. This may include personal identification, insurance information, medical records, and any relevant treatment history.
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Research and select a reputable partial hospitalization program in Rochester. Consider factors such as location, treatment approach, and available resources.
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Contact the chosen program and inquire about their admissions process. They will provide you with specific instructions on how to fill out their program's application forms.
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Complete the application forms accurately and thoroughly. Double-check for any missing or incomplete information.
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Attach any required supporting documents, such as medical records or referral letters, to the application.
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Review the completed application and supporting documents carefully to ensure accuracy and clarity.
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Submit the application to the partial hospitalization program either by mail, email, or in person, following the program's specific submission instructions.
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After submitting the application, you may be required to schedule an assessment or consultation with the program's staff. This assessment will help determine if the partial hospitalization program is appropriate for your needs.
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If accepted into the program, carefully review and sign any required consent forms or treatment agreements.

Who needs a partial hospitalization program in Rochester?

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Individuals who require intensive mental health treatment but do not require 24-hour hospitalization may benefit from a partial hospitalization program.
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People struggling with severe mental health conditions such as depression, anxiety disorders, bipolar disorder, post-traumatic stress disorder (PTSD), or substance abuse disorders may find a partial hospitalization program helpful.
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Individuals who have completed inpatient treatment but still require a structured treatment environment and therapeutic support can benefit from a partial hospitalization program.
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Those who need a step-down level of care after being discharged from a psychiatric hospital or emergency room may find a partial hospitalization program to be a suitable transition.
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People who want to actively participate in their treatment while maintaining their daily responsibilities and support systems can consider a partial hospitalization program.
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