Get the free BCMH/HMG REFERRAL FORM - myfcph.org

Franklin CountyPublic HealthBCMH/BMG REFERRAL FORM Franklin County Public Health 280 East Broad Street Columbus, Ohio 432154562 (614) 5253160 www.myfcph.orgBCMH Program*****Only a Referring Agency

How to fill out bcmhhmg referral form

How to fill out bcmhhmg referral form

1. Start by opening the BCMHHMG referral form.
2. Fill out the patient's personal information section which includes name, date of birth, address, and contact information.
3. Provide details about the referring physician or healthcare provider, including their name, specialty, and contact information.
4. Indicate the reason for the referral and any specific concerns or medical conditions that need attention.
5. Specify the preferred appointment date and time, if applicable.
6. Include any relevant medical history or test results that may be beneficial for the receiving physician.
7. Sign the form and include the date of referral.
8. Double-check all the information provided for accuracy and completeness.
9. Submit the filled-out referral form to the appropriate healthcare facility or provider.
10. Keep a copy of the referral form for your records.

Who needs bcmhhmg referral form?

1. BCMHHMG referral form is needed by patients who are being referred to a specialist or another healthcare provider within the BCMHHMG network. This form helps ensure a seamless transfer of medical information and facilitates the coordination of care between healthcare providers.

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What is bcmhhmg referral form?

BCMHHMG referral form is a document used to refer patients to the Behavioral Health Managed Care organization.

Who is required to file bcmhhmg referral form?

Healthcare providers or professionals who are referring patients to the Behavioral Health Managed Care organization are required to file the bcmhhmg referral form.

How to fill out bcmhhmg referral form?

The bcmhhmg referral form can usually be filled out electronically or manually by providing necessary patient information, provider details, and reason for the referral.

What is the purpose of bcmhhmg referral form?

The purpose of the bcmhhmg referral form is to facilitate the referral process and ensure smooth transition of patients to Behavioral Health Managed Care organization for appropriate care and treatment.

What information must be reported on bcmhhmg referral form?

The bcmhhmg referral form must include patient's demographic information, provider's information, reason for referral, any relevant medical history, and any other supporting documentation.