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Chart No. Revised August, 2018CAROLINA BEHAVIORAL CARE CHILD/ADOLESCENT PATIENT REGISTRATION FORM Today's Date Patient Name Patient Sex:Patient DOB Patient Age Identify as: Patient SSN: Parent(s)/Guardian(s):
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Provide all the requested information regarding your behavioral health history, including any diagnoses, treatments, and medications.
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The Office of Behavioral Health is a government agency that oversees mental health and substance abuse services.
Healthcare providers and facilities that provide mental health and substance abuse services are required to file with the Office of Behavioral Health.
Providers can fill out the necessary forms online through the Office of Behavioral Health's website or by mail.
The purpose of the Office of Behavioral Health is to ensure that individuals have access to quality mental health and substance abuse services.
Providers must report information such as the types of services offered, number of patients served, and outcomes of treatment.
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