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Get the free DMH REFERRAL / EMERGENCY INFORMATION FORM

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LIFESTYLES REFERRAL Please fill out and return to: Kerry Roberts Canton Site Donovan Bldg. 2nd floor 5 Randolph Street, Canton MA 02021 Tel # 7814019700 Fax: 7814019721 1. Client Name: 3. Date of
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How to fill out DMH referral emergency information:

01
Start by gathering all necessary information and documents, such as your personal identification, contact information, and any relevant medical history or diagnoses.
02
Locate the DMH referral form and ensure that you have the correct version for emergency information.
03
Begin filling out the form by entering your full name, date of birth, and any other requested identifying information.
04
Provide your current address and contact details, including phone numbers and email addresses.
05
Include information about any emergency contacts that should be notified in case of a crisis or if you become unable to communicate.
06
Provide detailed information about any pre-existing medical conditions, allergies, or medications that may be relevant in an emergency situation.
07
If applicable, include details of any mental health diagnoses or history that may be important for emergency responders or healthcare professionals to know.
08
Sign and date the form, indicating that the information provided is accurate and complete.
09
Make copies of the filled-out form for your records and keep them in a safe and easily accessible place.
10
If required, submit the form to the appropriate DMH office or healthcare provider as instructed.

Who needs DMH referral emergency information:

01
Individuals who have been referred to the Department of Mental Health (DMH) for emergency services.
02
People with mental health concerns or diagnoses who may require emergency intervention or support.
03
Those who have a history of mental health crises or are at risk of experiencing a mental health emergency in the future.
04
Caregivers or family members of individuals with mental health needs who may need to provide emergency information on their behalf.
05
Healthcare providers or professionals who are involved in the care or treatment of individuals with mental health concerns and require access to emergency information.
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DMH referral emergency information includes important contact information for emergency situations related to mental health services.
Providers and organizations that offer mental health services are required to file DMH referral emergency information.
DMH referral emergency information can be filled out by providing the necessary contact details and emergency protocols related to mental health services.
The purpose of DMH referral emergency information is to ensure that appropriate measures can be taken in case of emergencies involving mental health services.
DMH referral emergency information should include contact numbers, emergency procedures, and relevant details about mental health services.
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