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Mental Health Targeted Case Management Coverage and Limitations HandbookAPPENDIX B AGENCY CERTIFICATION CHILDREN IS MENTAL HEALTH TARGETED CASE MANAGEMENT Agency Name Agency AddressPhone Number ()Medicaid

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How to fill out baker act user reference

01

To fill out a Baker Act user reference, follow these steps:

02

Start by gathering the necessary information about the individual for whom the reference is being filled out.

03

Begin the reference by providing the individual's full legal name, date of birth, and contact information.

04

Include the reason for the reference and describe the relationship between the individual filling out the reference and the person being referred.

05

Provide a detailed account of the individual's mental health history, including any relevant diagnoses, treatments, medications, and hospitalizations.

06

Summarize the individual's current mental health status and any observed behaviors or symptoms that support the need for a Baker Act evaluation.

07

Include any recommendations or suggestions for the evaluation or treatment of the individual, based on the information provided.

08

End the reference by providing the contact information of the person filling it out, in case further clarification is needed.

09

Review the reference for completeness and accuracy before submitting it as required.

10

Remember to respect the privacy and confidentiality of the individual while providing an honest and thorough assessment.

Who needs baker act user reference?

01

Baker Act user reference is needed by individuals who are involved in the mental health evaluation or treatment process for someone who may be at risk of self-harm or harm to others.

02

This may include mental health professionals, physicians, law enforcement officers, family members, or concerned individuals who have direct knowledge or interaction with the person in question.

03

The Baker Act user reference serves as a supporting document to provide relevant information about the individual's mental health background and current status for the purpose of determining the need for a Baker Act evaluation.

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