Get the free Adolescent PHP Referral Form - hahv

Adolescent Partial Hospitalization Program 105 Mary s Avenue, One North, Kingston, New York 12401 Telephone (845) 334-3110 Fax (845) 334-4972 REFERRAL FORM FOR ADOLESCENT PHP The Adolescent Partial

How to fill out adolescent php referral form

How to fill out the adolescent PHP referral form:

1. Start by reviewing the instructions: Carefully read through the instructions provided with the adolescent PHP referral form. This will give you an understanding of what information needs to be included and any specific guidelines to follow.
2. Personal information: Begin by filling out the personal information section of the form. This typically includes the adolescent's name, date of birth, gender, address, and contact details. Ensure that all the information provided is accurate and up to date.
3. Guardian information: If the adolescent has a legal guardian, include their contact information in this section. This may require providing the guardian's name, relationship to the adolescent, address, and contact details.
4. Medical history: Provide a detailed medical history of the adolescent. This may involve listing any current medical conditions, past illnesses or injuries, medications being taken, and any additional information relevant to the adolescent's health.
5. Reason for referral: Clearly state the reason for the referral in the designated section. This could involve describing the specific mental health concerns or behavioral issues that require intervention or treatment.
6. Attach supporting documentation: If there are any supporting documents that need to be included with the referral form, ensure that they are properly attached. This may involve medical reports, diagnostic assessments, or any other relevant documents that provide additional information about the adolescent's situation.
7. Consultation with professionals: Consider consulting with mental health professionals or medical practitioners involved in the adolescent's care before submitting the referral form. This can help ensure that all the necessary information is included and increase the chances of a successful referral.

Who needs adolescent PHP referral form?

1. Parents or legal guardians: Parents or legal guardians of adolescents who require mental health services may need to complete the adolescent PHP referral form. This allows them to request specialized care and intervention for their child.
2. Healthcare professionals: Mental health professionals, such as therapists, psychologists, or psychiatrists, may also need to access the adolescent PHP referral form in order to refer a client to a PHP program. This form helps ensure that all relevant information is provided to facilitate appropriate treatment.
3. School personnel: School counselors, teachers, or administrators who are concerned about an adolescent's mental health may also need to complete the adolescent PHP referral form. This can help initiate the process of connecting the adolescent with the necessary support and services.

Overall, the adolescent PHP referral form is essential for individuals involved in the care of adolescents who require additional mental health services. It serves as a way to communicate the concerns and needs of the adolescent, allowing for appropriate treatment and intervention to be provided.

For pdfFiller’s FAQs

What is adolescent php referral form?

The adolescent php referral form is a document used to refer adolescents to a Partial Hospitalization Program (PHP) for mental health treatment.

Who is required to file adolescent php referral form?

Healthcare providers, mental health professionals, or parents/guardians of adolescents who are in need of PHP services are required to file the adolescent php referral form.

How to fill out adolescent php referral form?

The form must be completed with the adolescent's personal information, medical history, reason for referral, and any other relevant details related to their mental health.

What is the purpose of adolescent php referral form?

The purpose of the adolescent php referral form is to facilitate the referral process for adolescents who require mental health treatment in a PHP setting.

What information must be reported on adolescent php referral form?

The form must include the adolescent's name, age, contact information, medical history, mental health concerns, reason for referral, and any relevant medical records.

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