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REVISED 10.16.2019 Tell # 866 7029026 Fax # 719 5381439Tele # 877 8706735 (option 2 & 4) Fax # 877 8995611Behavioral Health / Medical Care Coordination Referral Form Northern Colorado Member Visiting
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How to fill out behavioral health medical care

01
To fill out behavioral health medical care, follow these steps:
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Begin by gathering all necessary information, such as your personal details, medical history, and insurance information.
03
Contact your behavioral health care provider or visit their website to obtain the necessary forms or documentation.
04
Carefully read and understand the instructions provided with the forms. Pay attention to any specific requirements or additional documentation that may be required.
05
Fill out the forms accurately and completely. Provide all necessary information, including your symptoms, current medications, and any previous treatments or therapy.
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If you are unsure about any questions or sections, seek clarification from your behavioral health care provider before submitting the forms.
07
Double-check the completed forms for any errors or missing information. Make sure your contact information is accurate so that the provider can reach you if necessary.
08
Submit the filled-out forms to your behavioral health care provider through the designated method, such as in-person, fax, or online submission.
09
Keep a copy of the filled-out forms for your records.
10
Follow up with your behavioral health care provider to ensure that they have received and processed your forms. Ask for any further instructions or appointments if necessary.
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Attend any scheduled appointments or follow-up sessions as recommended by your provider to receive the appropriate behavioral health medical care.

Who needs behavioral health medical care?

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Behavioral health medical care is needed by individuals who are experiencing mental health or substance abuse issues.
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This includes but is not limited to:
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- Individuals with anxiety disorders, depression, bipolar disorder, schizophrenia, or other mental health conditions.
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- Individuals struggling with addiction to drugs or alcohol.
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- Individuals who have experienced traumatic events or are dealing with post-traumatic stress disorder (PTSD).
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- Individuals with eating disorders, personality disorders, or other behavioral health concerns.
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- Individuals in need of counseling or therapy for emotional or psychological well-being.
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It is important to seek behavioral health medical care if you or someone you know is facing any of these challenges. Professional care can provide support, diagnosis, treatment, and resources to improve overall mental health and well-being.
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Behavioral health medical care refers to the treatment and support services provided to individuals experiencing mental health and substance use issues.
Providers of behavioral health services, such as therapists, counselors, psychiatrists, and treatment facilities, are required to file behavioral health medical care.
Behavioral health medical care can be filled out by documenting the services provided, diagnoses, treatment plans, and outcomes for individuals receiving behavioral health services.
The purpose of behavioral health medical care is to ensure that individuals receive appropriate and effective treatment for mental health and substance use issues, leading to improved overall health and well-being.
Information such as the type of services provided, diagnoses, medications prescribed, treatment plans, progress notes, and outcomes must be reported on behavioral health medical care forms.
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