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BEHAVIORAL and PSYCHIATRIC HEALTH SERVICES REFERRAL FORM Service Requested:IHTTT&SReferral Date / / Medication ManagementOutpatientReferring Source: Referral Name: Telephone Email Member Information:
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Gather all necessary personal and medical information.
02
Research and find a reputable behavioral and psychiatric health provider.
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Contact the provider and schedule an appointment.
04
Arrive at the appointment on time.
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Complete any required forms or questionnaires regarding your health history and symptoms.
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Be prepared to discuss your concerns, thoughts, and emotions openly and honestly with the healthcare provider.
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Follow any instructions or recommendations provided by the healthcare professional regarding treatment options.
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Attend scheduled therapy sessions or take prescribed medications as advised.
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Keep track of any changes or improvements in your mental health.
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Communicate regularly with your healthcare provider and provide updates regarding your progress.

Who needs behavioral and psychiatric health?

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Individuals experiencing symptoms of mental health disorders such as anxiety, depression, bipolar disorder, or schizophrenia.
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People who are struggling with substance abuse or addiction issues.
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Those who have experienced trauma or are dealing with post-traumatic stress disorder (PTSD).
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Individuals with behavioral or emotional issues impacting their daily functioning and interpersonal relationships.
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Anyone seeking support and guidance in managing their mental and emotional wellbeing.
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Behavioral and psychiatric health refers to the mental health and emotional well-being of individuals.
Healthcare providers, mental health professionals, and organizations may be required to file behavioral and psychiatric health reports.
Behavioral and psychiatric health forms can be filled out by providing detailed information about a patient's mental health history and current condition.
The purpose of behavioral and psychiatric health reports is to assess, diagnose, and treat mental health disorders and provide appropriate care and support.
Information such as patient demographics, medical history, mental health symptoms, diagnosis, treatment plan, and progress notes must be reported on behavioral and psychiatric health forms.
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