DHHS Form DMH 5-72-01 2009-2025 free printable template

It is my opinion that the respondent is exam done by Physician 2nd exam may be done by Qual. Prof. a substance abuser dangerous to himself or others SECTION II DESCRIPTION OF FINDINGS Clear description of findings findings for each criterion checked above in Section I must be described over Form No. DMH 5-72-01 Revised December 2009 Notable Physical Conditions Current Medications medical and psychiatric Impression/Diagnosis SECTION III - RECOMMENDATION FOR DISPOSITION Inpatient Commitment...

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How to fill out DHHS Form DMH 5-72-01

1. Obtain a copy of the DHHS Form DMH 5-72-01 from the official website or your local DHHS office.
2. Read the instructions carefully before starting to fill out the form.
3. Fill in your personal information at the top of the form, including your name, address, date of birth, and contact information.
4. Provide details about the services you are requesting or the purpose of the form in the relevant sections.
5. Include any required documentation or additional information as specified in the form instructions.
6. Review the completed form for accuracy and completeness.
7. Sign and date the form at the designated section.
8. Submit the form as instructed, either in-person, by mail, or electronically if applicable.

Who needs DHHS Form DMH 5-72-01?

1. Individuals seeking mental health services from the Department of Health and Human Services.
2. Caregivers or guardians filling out the form on behalf of someone else who requires services.
3. Any person or entity required to report or apply for assistance related to mental health support.

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People Also Ask about involuntary commitment forms

Who is the director of the NC Division of mental health?

Kelly Crosbie - Director, NC Division of Mental Health, Developmental Disabilities, and Substance Use Services - NC Department of Health and Human Services | LinkedIn.

Where is the best place to live for mental health services?

Key Findings New Jersey comes in as the number one best state to live in the US for your family's mental health in 2022. Data has shown that symptoms of mental illness among adults in New Jersey (16.14%) are lower than the national average in the US (21.1%)1.

Who regulates mental health facilities in NC?

The Mental Health Licensure and Certification Section of the Division of Health Service Regulation is responsible for licensing and regulating mental health, substance abuse, intellectual disability and developmental disability facilities in North Carolina.

Where does North Carolina rank in mental health?

Adult Ranking 2022 RankState20Virginia21North Carolina22South Carolina23West Virginia47 more rows

Which US state has the best mental health?

Wisconsin, Illinois and Pennsylvania have the best mental health care in the nation. Twenty-one percent of Americans have a mental health issue. Fifty-five percent of people with a mental illness aren't receiving care. Twenty-eight percent of people with a mental illness experience unmet needs.

What are the stats on mental health in NC?

As shown in the figure below, from February 1 to 13, 2023, 24.9% of adults in North Carolina reported symptoms of anxiety and/or depressive disorder, compared to 32.3% of adults in the U.S.

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What is DHHS Form DMH 5-72-01?

DHHS Form DMH 5-72-01 is a form used by the Department of Health and Human Services for reporting specific data related to mental health services.

Who is required to file DHHS Form DMH 5-72-01?

Entities providing mental health services, including facilities and providers receiving state funding, are required to file DHHS Form DMH 5-72-01.

How to fill out DHHS Form DMH 5-72-01?

To fill out DHHS Form DMH 5-72-01, you need to provide accurate data regarding mental health services rendered, complete all required sections, and submit it to the appropriate department according to the guidelines.

What is the purpose of DHHS Form DMH 5-72-01?

The purpose of DHHS Form DMH 5-72-01 is to collect data that helps in monitoring, evaluating, and planning mental health services within the state.

What information must be reported on DHHS Form DMH 5-72-01?

The information that must be reported includes details about the services provided, client demographics, service outcomes, and any other relevant data as specified by the form instructions.