CA MH 713 2013 free printable template
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Social environment Housing Economics Other psychosocial/environmental Axis V Current GAF Access to health care Inadequate information Occupational Involve w/Legal Sys DMH Dual Diagnosis Code III. S. Affect Appropriate Labile Constricted Blunted Flat Worried Rigid Memory Unimpaired Impaired re Immediate Amnesia Perceptual Disturbance Paranoid Nihilistic Grandiose Ideations Phobic Suspicious Obsessive Blames Others Persecutory Assaultive Ideas Magical Thinking Irrational/Excessive Worry Sexual...
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Obtain a copy of the CA MH 713 form from the official website or local office.
02
Read the instructions carefully to understand what information is required.
03
Fill in your personal details such as name, address, and contact information in the designated fields.
04
Provide information about your mental health history, as required by the form.
05
Include any relevant documentation to support your claims or statements.
06
Review the completed form for accuracy and completeness.
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Sign and date the form at the bottom.
08
Submit the form to the appropriate agency or office, either in person or via mail.
Who needs CA MH 713?
01
Individuals seeking mental health services in California.
02
Mental health professionals who need to refer clients for evaluation.
03
Agencies or organizations that manage mental health resources.
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What is CA MH 713?
CA MH 713 is a form used in California for reporting mental health services and billing information for Medi-Cal beneficiaries.
Who is required to file CA MH 713?
Providers of mental health services in California who seek reimbursement from Medi-Cal for their services are required to file CA MH 713.
How to fill out CA MH 713?
To fill out CA MH 713, providers must include information such as patient identification, service details, provider details, and billing codes as specified in the form's instructions.
What is the purpose of CA MH 713?
The purpose of CA MH 713 is to facilitate the proper billing and documentation of mental health services provided to Medi-Cal beneficiaries, ensuring compliance with state regulations.
What information must be reported on CA MH 713?
CA MH 713 requires reporting of patient demographics, service dates, type of service rendered, provider information, and relevant billing codes.
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