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MARYLAND BEHAVIORAL HEALTH ADMINISTRATION AFTERCARE REFERRAL FORM PART I BASIC Database: Name of Facility: Released to address: Date Admitted: / / Release Date: / / Type (Circle): DIS. OBS. A.L.J.

How to fill out aftercare referral form

How to fill out aftercare referral form

1. To fill out the aftercare referral form, follow these steps:
2. Start by entering the patient's basic information, such as their name, contact details, and date of birth.
3. Next, provide details about the patient's medical history, including any relevant diagnoses, medications, and past treatments.
4. Indicate the reason for the aftercare referral, specifying the type of care needed (e.g., counseling, physical therapy, etc.) and any specific instructions or preferences.
5. If applicable, include information about the referring healthcare provider or facility.
6. Finally, review the completed form for accuracy and completeness before submitting it to the intended recipient.

Who needs aftercare referral form?

1. The aftercare referral form is typically needed by healthcare professionals who are referring a patient for additional care or follow-up services.
2. This may include doctors, nurses, social workers, or other healthcare providers involved in the patient's treatment and care.

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What is aftercare referral form?

The aftercare referral form is a document used to refer individuals to follow-up care or support services after being discharged from a treatment facility.

Who is required to file aftercare referral form?

Medical professionals or treatment facility staff are usually required to file the aftercare referral form.

How to fill out aftercare referral form?

The aftercare referral form typically includes information about the individual's treatment history, current needs, and recommended follow-up care.

What is the purpose of aftercare referral form?

The purpose of the aftercare referral form is to ensure that individuals receive appropriate follow-up care and support after leaving a treatment facility.

What information must be reported on aftercare referral form?

The aftercare referral form may require information such as the individual's medical history, current medications, treatment plan, and contact information.