Get the free Complex Case Management Referral Form - Health Plan of ...

801 Gateway Blvd., Suite 100 South San Francisco, CA 94080 OB Complex Case Management Program Referral Form Please fax this completed form with any pertinent health records to 6508292047. To speak

How to fill out complex case management referral

How to fill out complex case management referral

1. To fill out a complex case management referral, follow these steps:
2. Gather all necessary information about the client, including their personal details, medical history, mental health status, and any other relevant information.
3. Contact the complex case management team or referring agency to obtain the referral form.
4. Fill out the referral form completely, providing accurate and detailed information about the client's needs, challenges, and goals.
5. Attach any supporting documents or reports that may be necessary for the referral process.
6. Double-check all the information provided on the referral form for accuracy and completeness.
7. Submit the completed referral form and supporting documents to the complex case management team or referring agency, following their preferred submission method (e.g., online, by mail, in person).
8. Follow up with the complex case management team or referring agency to ensure the referral has been received and processed.
9. Provide any additional information or clarification requested by the complex case management team during the referral review process.
10. Keep a copy of the completed referral form for your records.
11. Continue to communicate and collaborate with the complex case management team or referring agency as needed to support the client's case.
12. Note: The specific steps and requirements for filling out a complex case management referral may vary depending on the organization or agency involved. It is important to familiarize yourself with their guidelines and procedures.

Who needs complex case management referral?

1. Complex case management referral is typically needed by individuals who require specialized support and interventions due to complex and multiple needs. This may include individuals with:
2. - Chronic physical health conditions
3. - Severe mental health issues
4. - Substance abuse problems
5. - Intellectual or developmental disabilities
6. - Homelessness
7. - Involvement in the criminal justice system
8. - Limited access to healthcare or social services
9. - High-risk situations
10. Ultimately, the decision to refer an individual for complex case management should be based on a comprehensive assessment of their needs and the available resources and services.

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