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MH TCM Universal Transfer Form Submit Fax Request to: South Country Health Alliance 2300 Park Drive, Suite 100 Madonna, MN 55060Attn: SCHWA Behavioral Health Program 5074316936 (Phone) 5074316329
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How to fill out mh-tcm universal transfer form

01
To fill out the mh-tcm universal transfer form, follow these steps: 1. Start by entering the client's personal information, such as name, date of birth, and address.
02
Provide details about the client's current mental health treatment by listing the relevant providers, their contact information, and the services received.
03
Include information about the client's medication history, including medications currently being taken and any known allergies or adverse reactions.
04
Describe the client's psychiatric and medical history, including any previous diagnoses, hospitalizations, and significant medical conditions.
05
Document any current mental health symptoms or concerns reported by the client.
06
Indicate the level of the client's functioning by assessing their ability to perform daily activities and participate in social relationships.
07
Include any additional relevant information, such as legal or custody issues, cultural factors, or treatment preferences.
08
Sign and date the form to validate the information provided.
09
Submit the form to the appropriate recipient or agency as instructed.

Who needs mh-tcm universal transfer form?

01
The mh-tcm universal transfer form is typically needed by individuals who are receiving mental health treatment and require continuity of care when transitioning between different mental health service providers or agencies.
02
It ensures that important information about the client's treatment history, current status, and needs are properly communicated to the new provider, enabling them to continue providing appropriate care and support.
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The mh-tcm universal transfer form is a document used to transfer a patient's mental health and substance abuse treatment information between health care providers.
Health care providers and facilities involved in the treatment of mental health and substance abuse patients are required to file the mh-tcm universal transfer form.
The mh-tcm universal transfer form should be filled out completely and accurately, including the patient's personal information, treatment history, medications, and any other relevant details.
The purpose of the mh-tcm universal transfer form is to ensure seamless and coordinated care for mental health and substance abuse patients by transferring their treatment information between providers.
The mh-tcm universal transfer form must include the patient's demographic information, diagnosis, treatment history, medications, and any other relevant details of their mental health and substance abuse treatment.
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