CA Older Adult (Ages 60+) Full Service Partnership Referral and Authorization Form - County of Los Angeles 2010 free printable template

COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH OLDER ADULT (AGES 60+) FULL SERVICE PARTNERSHIP REFERRAL AND AUTHORIZATION FORM REFERRAL INFORMATION This confidential information is provided to

How to fill out dmh fsp referral form

How to fill out DMH FSP referral form:

1. Contact the local DMH (Department of Mental Health) office or visit their website to obtain the referral form.
2. Fill in your personal information, including your name, address, phone number, and date of birth.
3. Provide information about your mental health condition, including any diagnoses or treatments received.
4. Indicate whether you have any current or previous involvement with mental health services or programs.
5. Describe your current symptoms and any functional impairments they cause in your daily life.
6. Provide details about your support system, including any family members, friends, or professionals who are involved in your mental health care.
7. Explain your reasons for seeking FSP (Full Service Partnership) services and any specific goals you hope to achieve.
8. If applicable, include any additional information or documentation that supports your need for FSP services.
9. Review the completed form for accuracy and completeness before submitting it to the DMH office or mailing it to the provided address.

Who needs DMH FSP referral form:

1. Individuals who are experiencing mental health challenges and require additional support and services.
2. Individuals who would benefit from the comprehensive services provided by the DMH Full Service Partnership program.
3. People who have been diagnosed with a mental illness and have functional impairments that affect their daily functioning and overall wellbeing.

For pdfFiller’s FAQs

What is dmh fsp referral form?

The dmh fsp referral form is a document used to refer individuals to the Department of Mental Health's Full Service Partnership (FSP) program. It provides information about the individual's mental health needs and helps determine their eligibility for FSP services.

Who is required to file dmh fsp referral form?

Mental health providers, social workers, or individuals seeking FSP services on behalf of themselves or someone else may be required to file the dmh fsp referral form. The specific requirements may vary depending on the policies of the local Department of Mental Health.

How to fill out dmh fsp referral form?

To fill out the dmh fsp referral form, you will need to provide information about the individual's demographic details, mental health history, current symptoms and challenges, treatment history, and any relevant supporting documentation. The form can usually be obtained from the local Department of Mental Health or downloaded from their website.

What is the purpose of dmh fsp referral form?

The purpose of the dmh fsp referral form is to assess and determine an individual's eligibility for the Full Service Partnership program offered by the Department of Mental Health. It helps identify individuals who require intensive mental health services and support.

What information must be reported on dmh fsp referral form?

The dmh fsp referral form typically requires information such as the individual's name, contact details, date of birth, mental health diagnosis, treatment history, current symptoms and challenges, information about any co-occurring disorders, and any relevant supporting documentation.

When is the deadline to file dmh fsp referral form in 2023?

The specific deadline to file the dmh fsp referral form in 2023 may vary depending on the policies of the local Department of Mental Health. It is recommended to contact the Department or check their website for the accurate deadline information.

What is the penalty for the late filing of dmh fsp referral form?

The penalties for the late filing of the dmh fsp referral form can vary depending on the policies of the local Department of Mental Health. It is advisable to consult with the Department or refer to their guidelines to determine the specific penalties or consequences for late filing.

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