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BEHAVIORAL HEALTH EMERGENCY SERVICES CONTACT FORM Jerrold Pollack, Ph.D.IDENTIFYING INFORMATION Date of Contact Start Time End Time Clinician receiving call: Name Degree Identity of caller: Client:
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How to fill out behavioral health emergency services

01
Gather all necessary information and documents, such as identification, insurance information, and any relevant medical history.
02
Find a behavioral health emergency services provider near you.
03
Call the provider's emergency contact number, which is usually available 24/7.
04
Be prepared to provide a brief description of the situation and any symptoms or concerns.
05
Follow any instructions given by the provider, which may include coming to their location or arranging for transportation.
06
Once at the facility, provide all requested information honestly and accurately.
07
Cooperate with the healthcare professionals and answer their questions to the best of your ability.
08
Follow the recommended treatment plan and attend any follow-up appointments or therapy sessions as advised.
09
Inform the provider if there are any changes or new developments in the situation.
10
Take care of yourself and seek support from loved ones or trusted individuals during this time.

Who needs behavioral health emergency services?

01
Individuals experiencing a mental health crisis or emergency.
02
People who are at risk of harming themselves or others.
03
Anyone with severe psychiatric symptoms that require immediate attention.
04
Individuals in acute emotional distress or experiencing extreme mood swings.
05
Those struggling with substance abuse or addiction and need immediate support.
06
Individuals with a history of self-harm or suicide attempts.
07
People who have recently experienced a traumatic event and need immediate psychological assistance.
08
Those with a diagnosed mental illness who are experiencing a severe exacerbation of symptoms.
09
Individuals who are unable to cope with daily functioning and require immediate professional intervention.
10
People who are unsure if they need behavioral health emergency services should reach out for guidance and evaluation.
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Behavioral health emergency services are crisis interventions for individuals experiencing a mental health or substance abuse crisis.
Healthcare providers, emergency responders, and mental health professionals are required to file behavioral health emergency services.
Behavioral health emergency services are typically filled out in a form provided by the local health department or crisis intervention center.
The purpose of behavioral health emergency services is to provide immediate support and intervention for individuals in crisis to ensure their safety and well-being.
Information such as the individual's name, contact information, a brief description of the crisis, and any relevant medical history must be reported on behavioral health emergency services.
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