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Behavioral Health Resources of Maine REFERRAL FORM Page 1 of 4PLEASE COMPLETE THIS FORM IN ITS ENTIRETY Incomplete forms may delay processing. Date / / Referent Name Email Referral Organization Phone
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How to fill out referral form - behavioral
How to fill out referral form - behavioral
01
To fill out a referral form for behavioral services, follow these steps:
02
Start by entering your personal details such as your name, contact information, and date of birth.
03
Specify the reason for the referral, providing details about the behavioral concerns or issues you are seeking assistance with.
04
If applicable, provide information about any previous evaluations or assessments related to the behavioral concerns.
05
Indicate whether you have previously received any behavioral services or interventions.
06
Include any relevant medical or mental health history that may impact the behavioral concerns.
07
If applicable, provide information about any current medications or treatments being received.
08
Finally, sign and date the referral form, ensuring that all information provided is accurate and complete.
Who needs referral form - behavioral?
01
Individuals who require behavioral services can benefit from filling out a referral form. This includes individuals experiencing behavioral concerns such as emotional or social difficulties, developmental delays, attention and hyperactivity issues, anxiety, depression, or disruptive behavior. Referral forms are typically completed by individuals themselves or by concerned family members, teachers, or healthcare professionals who have identified behavioral challenges that require intervention or specialized services.
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What is referral form - behavioral?
Referral form - behavioral is a document used to refer individuals to behavioral health services.
Who is required to file referral form - behavioral?
Behavioral health professionals, social workers, counselors, or medical professionals are required to file referral form - behavioral.
How to fill out referral form - behavioral?
Referral form - behavioral can be filled out by providing detailed information about the individual's behavioral health issues, symptoms, and any relevant history.
What is the purpose of referral form - behavioral?
The purpose of referral form - behavioral is to connect individuals in need of behavioral health services with appropriate resources and support.
What information must be reported on referral form - behavioral?
Information such as the individual's name, contact information, symptoms, behavioral health history, and any relevant medical information must be reported on referral form - behavioral.
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