Get the free Crisis Intervention Follow-Up Request Form - Providers - AmeriHealth Caritas Louisia...

Member/legal guardian signature Member and/or legal guardian declined Date Provider signature If you have any questions please contact Behavioral Health Utilization Management at 1-855-285-7466. All out-of-network provider requests will be reviewed for medical necessity of services. Please print clearly incomplete or illegible forms will delay processing. Member Information Member name Member date of birth Member ID number Legal guardian Member primary diagnosis Provider Information...

How to fill out crisis intervention follow-up request

How to fill out crisis intervention follow-up request

1. To fill out a crisis intervention follow-up request, follow these steps:
2. Begin by accessing the crisis intervention follow-up request form.
3. Provide your personal information, including your name, contact details, and any applicable identification numbers.
4. Indicate the date and time of the crisis intervention that you received, as well as the organization or individual who provided it.
5. Describe the nature of the crisis situation and the assistance that was provided to you during the intervention.
6. Explain the reason for the follow-up request and what specific support or services you require.
7. If there were any witnesses or other individuals involved in the crisis situation, provide their names and contact information if known.
8. Sign and date the form to complete your crisis intervention follow-up request.
9. Submit the form as instructed, either through mail, email, or in-person at the appropriate organization or individual's office.
10. Keep a copy of the filled-out request form for your records.
11. Await a response from the organization or individual responsible for handling crisis intervention follow-up requests.

Who needs crisis intervention follow-up request?

1. Individuals who have previously received crisis intervention assistance and require further support or services may need to submit a crisis intervention follow-up request.
2. This may include individuals who have experienced a recent crisis, such as a natural disaster, traumatic event, or emotional breakdown, and need continued assistance in their recovery process.
3. Crisis intervention follow-up requests are also relevant for those who have undergone crisis counseling or therapy and require ongoing support or maintenance sessions.
4. The specific criteria for who needs a crisis intervention follow-up request may vary depending on the policies and guidelines set by the organization or individual providing crisis intervention services.

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What is crisis intervention follow-up request?

Crisis intervention follow-up request is a formal request for additional support or assistance following an initial crisis intervention.

Who is required to file crisis intervention follow-up request?

Individuals who have received crisis intervention services and feel the need for further support are required to file a crisis intervention follow-up request.

How to fill out crisis intervention follow-up request?

To fill out a crisis intervention follow-up request, individuals must provide information about the original crisis, the services received, and the additional support needed.

What is the purpose of crisis intervention follow-up request?

The purpose of a crisis intervention follow-up request is to ensure that individuals receive ongoing support and assistance following a crisis situation.

What information must be reported on crisis intervention follow-up request?

Information such as the nature of the crisis, services received, additional support needed, and contact information must be reported on a crisis intervention follow-up request.