CT PRTF Referral Form 2014 free printable template

PROF Referral Form SERVING Boys & Girls Village The Children s Center of Hamden Albert J. Sol nit South Campus PROF Albert J. Sol nit North Campus PROF 528 Wheelers Farms Rd Milford, CT 06461 T: 203-877-0300

How to fill out CT PRTF Referral Form

How to fill out CT PRTF Referral Form

1. Gather patient information including name, date of birth, and contact details.
2. Obtain the referring party's information such as name, title, and contact details.
3. Fill out the reason for referral, specifying the patient's needs and circumstances.
4. Include any previous treatment history or relevant medical information.
5. Attach any necessary documentation, such as diagnostic evaluations or assessments.
6. Review the form for completeness and accuracy before submission.
7. Submit the completed form to the appropriate referral agency or contact person.

Who needs CT PRTF Referral Form?

1. Individuals seeking mental health treatment options.
2. Parents or guardians of children requiring specialized psychiatric residential treatment.
3. Mental health professionals who need to refer patients to a Psychiatric Residential Treatment Facility (PRTF).
4. Social workers involved in the care and placement of individuals in need of mental health services.

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What is CT PRTF Referral Form?

The CT PRTF Referral Form is a document used to refer individuals to Psychiatric Residential Treatment Facilities (PRTF) in the state of Connecticut.

Who is required to file CT PRTF Referral Form?

The CT PRTF Referral Form must be filed by healthcare providers, including physicians or mental health professionals, who are referring a patient to a PRTF.

How to fill out CT PRTF Referral Form?

To fill out the CT PRTF Referral Form, providers should complete all sections of the form, including patient demographics, medical history, and the reason for referral, ensuring all required information is accurately provided.

What is the purpose of CT PRTF Referral Form?

The purpose of the CT PRTF Referral Form is to facilitate the admission process for patients seeking treatment at a PRTF and to ensure that all necessary information is collected for appropriate patient care.

What information must be reported on CT PRTF Referral Form?

The information that must be reported on the CT PRTF Referral Form includes the patient's name, date of birth, contact information, medical history, presenting issues, and any relevant treatment history.