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Page 1 of 4 Child Name: IIC APS Site: Wheeler Clinic Site Director: Jill Lambert, LCSW 8607934413 phone 8607934460 handicaps Referral and Critical Information Form Date of ReferralReferral SourceChild's
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What is iicaps referral form?
IICAPS referral form is a form used to refer a child or adolescent to the Intensive In-home Child and Adolescent Psychiatric Services program.
Who is required to file iicaps referral form?
Providers, clinicians, or caretakers who believe a child or adolescent would benefit from the IICAPS program are required to file the referral form.
How to fill out iicaps referral form?
The referral form can be filled out by providing detailed information about the child/adolescent's mental health history, current needs, and reasons for seeking IICAPS services.
What is the purpose of iicaps referral form?
The purpose of the IICAPS referral form is to assess the needs of a child or adolescent and determine if they qualify for intensive in-home psychiatric services.
What information must be reported on iicaps referral form?
Information such as the child/adolescent's mental health history, current symptoms, diagnoses, treatment history, and reasons for seeking IICAPS services must be reported on the referral form.
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